Stroke and TIA

Question 1

What are some potential causes of stroke in young people?

Answer 1

Sudden BP drop >40mmHg
Carotid artery dissection 
Subarachnoid haemorrhage
Antiphospholipid syndrome
Fabry's disease

Question 2

What are some Ddx for stroke?

Answer 2

TIA, head injury, hypo/hyperglycaemia, hemiplegic migraine, post ictal, Wernicke’s

Question 3

What are the signs of a cerebral infarct?

Answer 3

CL sensory loss
CL hemiparesis (flacid -> spastic) (UMN)
Dysphasia
Homonymous hemianopia 
Visuo-spatial defect

Question 4

What are the signs of a brainstem infarct?

Answer 4

Quadriplegia, gaze/vision disturbances, locked in syndrome

Question 5

What are the symptoms of a lacunar infarct?

Answer 5

ataxic hemiparesis/pure motor/pure sensory/sensorimotor/dysarthria (clumsy hand)
Cognition and consciousness intact

Question 6

How is stroke managed?

Answer 6

Maintain glocuse, leave BP treatment unless dangerouse HTN
CT within an hour
Anti-platelet (300mg) - haemorrhagic stroke rule out
Thrombolysis <4.5hrs
- Alteplase
Acute stroke unit

Question 7

What medication is started after a stroke?

Answer 7

Antiplatelet - aspirin (300, 14 days) -> clopidogrel
Statin
Anti-hypertensive - Thiazide diuretics/CCB/ACE-i

Question 8

What is aspirin replaced with if a patient has atrial fibrillation/flutter?

Answer 8

Warfarin

or DOAC - Rivoroxaban, apixaban