Stroke and TIA Flashcards

1
Q

What is the definition of a stroke and TIA?

A

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

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2
Q

How common are stokes?

A

Approximately 152000 strokes a year in the UK

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3
Q

Explain the pathophysiology of a stroke/TIA?

A

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

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4
Q

What are the risk factors/aetiology?

A
  • 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
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5
Q

What are the signs/symptoms of strokes and TIA’s?

A
  • 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
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6
Q

What investigations are carried out for a suspected stroke?

A
  • 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
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7
Q

How will having a stroke/TIA affect a patients ability to drive?

A

Patients should not drive for a month after a TIA or stroke – maybe longer if there are complications/brain surgery involved

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8
Q

What are the surgical treatments for a stroke?

A

• Carotid endarterectomy – for patients with carotid artery stenosis

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9
Q

What are the pharmacological treatments for a stroke?

A
  • Thrombolysis – ischemic stroke only, must be given within 4.5 hours of the stroke
  • Aspirin – ischemic
  • Anticoagulant
  • Antihypertensives
  • Statin
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10
Q

What are the non pharmacological treatments for a stroke?

A
  • ABCD2 risk score – risk of stroke after a TIA
  • Speech and language therapy
  • Physiotherapy
  • Occupational therapy
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