Stroke and TIAs ☺️

Question 1

What is a stroke

-subtypes

Answer 1

Sudden interruption of blood supply in brain
Ischemic (85%)
-thrombosis of large vessels (carotid)
-embolic from clot/fat/air/septic

Haemorrhagic (15%)

• intracerebral
• subarachnoid

Question 2

Risk factors for

• ischemic stroke
• haemorrhagic stroke

Answer 2

General risk factors

• HTN
• age

Ischemic stroke

• smoking
• hyperlipidemia
• DM
• AF

Haemorrhagic stroke

• AVM
• anticoagulation

Question 3

What are the symptoms of a stroke?

What are the signs of a stroke mimic?

Answer 3

ACUTE SUDDEN FOCAL NEURO LOSS
-Unilateral weakness/paralysis in face, arm, leg
-Dysarthria, expressive/receptive dysphasia
Vision problems
-Headache (sudden severe and unusual headache)
-Ataxia
-Vertigo or loss of balance

MIMICS

• Neurological symptoms that are gradual in onset, progressive, migratory
• Positive neurological symptoms, (flashing lights or tingling, jerking, or shaking of limbs)
• Cognitive impairment
• Respiratory, abdominal or other abnormal signs

Question 4

How would you manage a suspected stroke

-how would this differ in ischemia or haemorrhage?

Answer 4

Non enhanced CT immediately to assess for ischemic or haemorrhagic
Support with O2 and glucose if needed
ADMIT TO STROKE UNIT
-decompressive craniectomy to relieve ICP = LAST RESORT

Ischemic

• aspirin 300mg
• thrombolysis alteplase
• may use thrombectomy
• assess for carotid stenosis => endarterectomy, stenting

Haemorrhagic

• STOP anticoagulants and antiplatelets
• lower BP
• reduce DVT risk => pneumatic leg compressions, caval filter, anticoagulants

Question 5

How would you reduce the risk of a future TIA/stroke?

• lifestyle
• medications
• comorbidities

Answer 5

Physical activity
Smoking cessation
Diet
-5fruit and veg
-2 portions of oily fish
-reduced sat fats, salt
Alcohol
-max 14 units over 1 wk

Antiplatelet - 75mg clopidogrel
Statins - atorvastatin unless haemorrhagic
Antihypertensives - thiazide/CCB/ACEi
Anticoagulants - warfarin/Xinh

T2DM
HF
POP/non hormonal contraceptives
Yearly flu vaccines

Question 6

How would you assess the location of the stroke

-cerebral infarct

Answer 6

Cerebral

• contralateral hemiplegia - flaccid => spastic
• contralateral sensory loss
• contralateral homonymous hemianopia
• dysphasia

Question 7

How would you manage a suspected TIA?

Answer 7

Within the week

• 300mg aspirin
• assessment within 24hrs

More than a week
-assessment within the week