Stroke: Flashcards
What is a TIA?
A transient and reversible episode of sudden onset neurological dysfunction caused by ischaemia, without acute infarction.
How long do symptoms usually resolves by?
24hrs
Give the two circulations which can be affected in TIAs:
Anterior (carotid territory) - hemiparesis, hemi sensory disturbance, dysphasia, amaurosis fugax
Posterior (vertebrobasilar) - affects brainstem: LOC, bilateral motor/sensory dysfunction, binocular vision
What is amaurosis fugax?
Common TIA presentation: Painless transient monocular visual loss - curtain coming down vertically into field of vision. Occurs due to temporary reduction in retinal, opthalmic or ciliary blood flow = retinal hypoxia.
Give 2 DD for TIA:
- Stroke
- Hypoglycaemia
- Migraine aura
What investigations should be performed for those with suspected TIA?
- ECG - look for AF
- Echocardiogram or cardiac monitoring
- Doppler US of carotids - to assess stenosis
What score is used to asses stroke risk following a TIA?
ABCD2 score
What management should ‘high risk’ TIAs have?
Refer to specialist assessment within 24hrs of symptom onset.
What management should those with ‘low risk’ TIA have?
- Control CVS risk factors
- 2 weeks of 300mg aspirin
- Antiplatelet therapy - clopidogrel 75mg (or modified-release dipyridamole)
- Statin
What should someone with an TIA not do for 4 weeks?
Drive
What is a Cerebrovascular accident defined as?
A clinical syndrome caused by disruption of blood supply to the brain, characterised by rapidly developing signs of focal or global disturbance or cerebral functions, lasting more than 24hrs or leading to death.
What is the cause of strokes?
Ischaemic (70%)
Haemorrhage (30%)
Give 4 causes of strokes:
- Cardiac emboli
- Atherthromboemboli
- CNS bleed (trauma, aneurysm rupture)
- Hyperviscosity
Give the signs and symptoms based on the area of the stroke:
Total anterior circulation stroke (TACS):
- Unilateral weakness of face, arm and leg
- Homonymous hemianopia
- higher cerebral dysfunction (dysphasia)
Partial Anterior Circulation Stroke (PACS):
- 2 of the 3 for a TACS
Posterior Circulation Syndrome (POCS). One of:
- Cerebellar or brainstem syndromes
- Loss of consciousness
- Isolated homonymous hemianopia
Lacunar syndrome (LACS). Subcortical (midbrain, internal capsule) - one of:
- unilateral weakness of face and arm. arm and leg or all three
- Pure sensory loss
- Ataxic hemiparesis
What investigations should be performed in someone with suspected stroke?
- Urgent CT head before treatment (rule out haemorrhagic stroke)
- MRI
- BP/ECG/BMs
