Stroke and TIA

Question 1

Define stroke

Answer 1

A stroke is an acute neurological deficit attributed to an acute focal injury of the brain, spinal cord, or retina by either a vascular occlusion (ischaemia) or haemorrhage.

Question 2

Define TIA

Answer 2

A transient ischaemic attack (TIA) is a sudden-onset focal neurological deficit with a vascular aetiology, typically resolving symptoms within less than 1 hour.

Question 3

Define amaurosis fugax

Answer 3

Loss of vision in one eye - symptom of TIA. Normally painless and transient

Question 4

What are the risk factors for a TIA/stroke?

Answer 4

Hypertension
Smoking
Poor exercise and diet
Atrial fibrillation
Diabetes
Alcohol
AGE >55
Ethnicity - black and asian
Male
Family hx
Heart disease
Prior stroke/TIA

Question 5

What are the signs of raised ICP?

Answer 5

Headache
Vomiting
Papilloedema
Reduced levels of conciousness
Cushings Triad

Question 6

What is Cushings Triad ?

Answer 6

Widening pulse pressure
Bradycardia
Irregular breathing

Question 7

What is the classification system used for strokes?

Answer 7

Bamford system

Question 8

What is a TACS stroke

Answer 8

Total anterior circulation stroke (TACS)
Large cortical stroke affecting the areas of the brain supplied by both the middle and anterior cerebral arteries.

Question 9

What is a PACS stroke?

Answer 9

A partial anterior circulation stroke (PACS) is a less severe form of TACS, in which only part of the anterior circulation has been compromised.

Question 10

What is a POCS stroke?

Answer 10

A posterior circulation syndrome (POCS) involves damage to the area of the brain supplied by the posterior circulation (e.g. cerebellum and brainstem).

Question 11

What is a LACS stroke?

Answer 11

A lacunar stroke (LACS) is a subcortical stroke that occurs secondary to small vessel disease. There is no loss of higher cerebral functions (e.g. dysphasia).

Question 12

Which artery is most commonly affected by a stroke?

Answer 12

Middle Cerebral Artery

Question 13

What is the mechanism of stroke?

Answer 13

Arterial embolism – from a distant site; e.g. carotids, vertebral or basilar arteries. The embolus will occlude an artery of the brain resulting in infarction. May also come from heart valves in endocarditis.

Haemorrhage – can be in the cerebrum itself, or also a subarachnoid haemorrhage may cause a similar effect