Stroke and TIA Flashcards
National Institutes of Health Stroke Scale
0 - No stroke symptoms 1-4 - Minor stroke 5-15 - Moderate stroke 16-20 - Moderate to severe stroke 21-42 - Severe stroke
Composed of 11 items
Subtypes
Cerebral infarction (85%) - atheroembolism, embolism, arterial dissection, inflammatory vasculopathies
Intracerebral haemorrhage (15%) - rupture of blood vessels resulting in direct neuronal injury and cerebral oedema. Usually in anterior / posterior communicating or branches of middle cerebral and basilar arteries
The Barthel Index
Used to monitor ADLs after a stroke
Thrombolysis Inclusion Criteria
Symptoms of acute stroke
Onset in last 4.5 hours
Measurable deficit on NIHSS
Absence of haemorrhage on CT scan
Thrombolysis
Alteplase - tissue plasminogen activator
6% risk of haemorrhage (2-3% major), 7% risk of angio-oedema (increased with ACE inhibitors)
Checklist
Always do a CT scan 24h post thrombolysis to identify bleeds
TIA - < 24 hours
Transient - the patient must have been fully recovered by the time the diagnosis is made
Ischaemic - the neurological symptoms need to fit with the territory of an artery
Attack - sudden onset
Crescendo TIA
TIAs need to be referred to the TIA clinic. Calculate risk score to see how urgently the patient needs to be seen (everyone with a suspected TIA should be seen by a specialist within 7 days)
ABCD2 score:
Age >/ 60 = 1
BP >/ 140/90 = 1
Clinical features: unilateral weakness = 2
speech disturbance without weakness = 1
Duration of symptoms: >/ 60m = 2, 10-59m = 1, < 10m = 0
Diabetes = 1
Some CI to thrombolysis
Head trauma, brain / spinal surgery, stroke in the past 3 months
Major surgery or non head trauma in the past 2 weeks
Known aortic dissection
Recent LP in last 10 days
Currently pregnant
History of intracranial haemorrhage, cerebreal aneurysm or AVM
Heparin or NOAC within last 48 hours
People who have had a suspected TIA and are at high risk of stroke (>/ 4) should:
Aspirin 300mg immediately
Specialist assessment within 24 hours
Measures for secondary prevention
Advised not to drive for 1 month
Differentials
Hypoglycaemia Migraine aura Focal epilepsy Hyperventilation MS
Tests
Blood glucose FBC, CRP, U&Es, lipids CXR ECG Carotid doppler +- angiography
Treatment
CV RF: reduce BP slowly, reduce cholesterol, stop smoking
Antiplatelets: aspirin 300mg daily for 2 weeks –> aspirin 75 mg daily + dipyridamole or clopidogrel 75mg /day (give lansoprazole with the aspirin)
Warfarin indications: cardiac emboli
Carotid endarterectomy
Stenosis >/ 70% - perform surgery within 2 weeks
50-70% - consider surgery (if team’s peri-op stroke and mortality rate <3%)
SPARC Tool - Stroke Prevention in Atrial Fibrillation Risk Tool
For estimating risk of stroke and benefits and risks of antithrombotic therapy in patient’s with chronic atrial fibrillation
ROSIER Score
Exclude hypoglycaemia, then assess:
*LOC / Syncope = -1, seizure activity = -1
New acute onest of: *Asymmetrical facial / arm / leg weakness = 1 *Speech disturbance = 1 * Visual field defect = 1 A stroke is likely if >0
