Stroke and TIA Flashcards
Define stroke
Sudden onset of rapidly developing focal or global neuro disturbance for >24h/until death
What is TIA
Episode of transient neuro dysfunction caused by focal brain/SC/retinal ischaemia without evidence of acute infarction.
<24hrs
What proportion of strokes are ischaemic vs haemorrhagic?
85% ischaemic
15% haemorrhagic
What is more common stroke or TIA?
Stroke
What do you need to cover in history
Symptoms- neuro defecit and assoc sx (headache, vomiting, consciousness)
Onset- when, what doing, progression of sx.
Risk factors- cardio disease, diabetes, hyperlipidaemia, smoking, pregnancy, recent trauma, illness/surgery, alcohol/drugs
R/O- migraine, GCA, preceding trauma, seizures
PMH- thrombophilia –> thromboembolic events, miscarrigae
FH- stroke
What if they don’t know the time of onset?
When do they last know that they were unaffected?
what examinations do you need to do?
ABC and vital signs
Cardio (HF, AF, murmurs, valvular HD, endocarditis)
Neuro including fundoscopy. FAST initial screen.
What do you look for on fundoscopy?
Intraocular haemorrhage (aneurysmal SAH)
What investigations?
blood glucose to r/o hypo
ECG exclude arryth and look for AF
What is the score for stroke vs stroke mimic?
ROSIER
What is ABCD2 score?
For TIA patients without neuro signs when seen. To assess risk of another TIA or of stroke.
> 4- assess within 24hr
<4- assess within 1w
Includes- age, BP, clinical features, duration
Very initial management of susp stroke
ASAP
Arrange immediate admission to stroke facility and in the mean time monitor and manage ABC- need to determine whether haemorrhagic or ischaemic
Imaging should be within 1hr
Can you start anti-platelet therapy immediately?
No wait until haemorrhagic r/o
What is the management if confirmed ischaemic?
Aspirin 300mg oral or rectal (NB safe swallow)
Thrombolysis IF within 4.5hrs symptom onset- alteplase
Absolute C/I to thrombolysis
Prev IC haemorrhage
Seizure at onset of stroke
Intracranial neoplasm
Susp SAH
Stroke/TBI preceding 3m
LP preceding 7 days
GI haemorrhage preceding 3w
Active bleeding
Pregnancy
Oesoph varices
Uncontrolled HTN (>200/120)
How long is the aspirin continued for
2w post stroke then definitive LT antithrombotic
Management haemorrhagic stroke
Surgical
Stop and reverse any anticoags they are on
TIA management
Aspirin 300mg
ABCD2 to determine risk
Refer (24h if high risk, 7 days if lower)
What investigations will someone who has had a TIA have?
Carotid USS
Echo
ECG
?CT
Does TIA need to inform DVLA? Can they still drive?
Not unless for work
Don’t drive for 1m
Secondary prevention drugs stroke and TIA
Clopidogrel 75mg OD
Atorvostatin 80mg OD
Antihypertensive IF INDICATED
Anticoag IF AF OR ATRIAL FLUTTER (warfarin or NOAC)
What is it called if they have >1 TIA?
Crescendo TIA
What if they present with TIA >1w after?
Specialist assessment ASAP within 7d and don’t drive until seen
If someone who presents with TIA already taking anticoag wyd?
Don’t give aspirin, they need imaging to exclude haemorrhage.
If already taking low dose aspirin, continue the low dose until reviewed by specialist.
what should you include in post-stroke review?
- Bowel and bladder
- Fatigue
- Nutrition and hydration
- Cognition
- Mood and wellbeing
- Mouth care
- Pain- neuro and MSK
- Sexual dysf
- Spacicity and contractures
- EoL care
Can you drive after stroke
Wait for at least a month, and get clearance from doctor.
Inform DVLA only if seizure, surgery needed or still complications 1m later
Can you drive if multiple TIAs?
If you have a number of TIAs over a short period of time, you will need to wait until you have not had any TIAs for three months before returning to driving.
