Stroke and TIA Flashcards
What is the definition of a stroke and TIA?
TIA: an acute onset, focal neurological deficit with vascular origin less than 24 hours (though most last less than an hour)
Stoke: an acute onset, focal neurological deficit with vascular origin longer than 24 hours
How common are stokes?
Approximately 152000 strokes a year in the UK
Explain the pathophysiology of a stroke/TIA?
Most strokes are ischemic
• Occur due to arterial embolism/thrombus
• Occurs in the carotid, vertebral or cerebral arteries
• TIA’s normally due to microemboli = temporary drop in perfusion
• Around 15% are haemorrhagic
• Lacunar – arms, face and legs are affected, higher cortical function preserved
• Partial anterior circulation infarct (TACI) – 2/3 of arm, face and legs affected and higher cortical defects
• Total anterior circulation stroke (PACS) – 2/3 of arm, face and legs affected and higher cortical defects and visual neglect
• Posterior circulation stroke (PCS) – cerebellar and brainstem signs e.g. lateral medullary syndrome
What are the risk factors/aetiology?
- Black origin
- Smoking
- Diabetes
- Obesity
- OCP
- ↑ alcohol
- Bleeding disorders = haemorrhagic stroke
- Anticoagulants = haemorrhagic stroke
- Hypertension = haemorrhagic stroke
- Cancer = haemorrhagic stroke
- Amyloid disease = haemorrhagic stroke
- AV malformations = haemorrhagic stroke
- AF = ischemic stroke
- Atherosclerosis in carotid arteries = ischemic stroke
- Vasculitis = ischemic stroke
- Patent foramen ovale = ischemic stroke
What are the signs/symptoms of strokes and TIA’s?
- Face
- Arms
- Speech
- Time
- Amaurosis fugax (shutter blindness of the eyes due to retinal artery occlusion) – TIA
- Hemisensory loss
- Hemianopic visual loss
- Chocking/dysarthria
- Diplopia
- Vertigo
- Vomiting
- Loss of consciousness – rare
- Carotid bruits
- Hemiparesis on the contralateral side
- Spasticity +/- clonus – UMN lesion
- Weakness in extensors of arms and flexors of legs – UMN lesion
- ↑ tendon reflexes – UMN lesion
- Pronator drift – UMN lesion
What investigations are carried out for a suspected stroke?
- FBC
- U&E
- Cholesterol
- Plasma viscosity
- Clotting/INR
- HbA1c
- ERS
- Creatinine
- CT – sometimes ischemic stroke doesn’t show for hours
- MRI – stroke shows within 15 mins
- Carotid Doppler
- Echo – check for patent foramen ovale, valve disease, enlarged artia, endocarditis
- ECG
- ABCD2 risk score – risk of stroke after a TIA
How will having a stroke/TIA affect a patients ability to drive?
Patients should not drive for a month after a TIA or stroke – maybe longer if there are complications/brain surgery involved
What are the surgical treatments for a stroke?
• Carotid endarterectomy – for patients with carotid artery stenosis
What are the pharmacological treatments for a stroke?
- Thrombolysis – ischemic stroke only, must be given within 4.5 hours of the stroke
- Aspirin – ischemic
- Anticoagulant
- Antihypertensives
- Statin
What are the non pharmacological treatments for a stroke?
- ABCD2 risk score – risk of stroke after a TIA
- Speech and language therapy
- Physiotherapy
- Occupational therapy