Stroke medicine Flashcards
What are TIAs?
- Focal neurological deficits due to blockage of blood supply to part of the brain
- Lasting less than 24hrs but in practice these are usually much less
Risk assessment for TIA to predict short term risk of stroke?
ABCD2 - but NOT a diagnostic tool
How is ABCD2 calculated?
Sum of points of 5 different factors inc:
* Age
* BP
* Clinical features
* Duration of symptoms
* Diabetes?
Cut off score for ABCD2
Score of 4 or more = higher risk of stroke
Management of high risk patients
- Prioritised to be seen in TIA clinic or by a stroke physician ASAP
- Aspirin 300mg daily if suspected TIA started immediatly
Investigations for TIA
- Bloods
- Carotid doppler
- CT or MRI
Treatment for TIA
- Lifestyle modifcations
- Treatment of high cholesterol and HTN
- Surgical intervention for carotid artery disease
- Antiplatelets if appropriate
What is crescendo TIA?
Two or more TIAs in a week - should be treated for high risk stroke
Define stroke
- Sudden onset of focal neurological deficit
- Lasting more than 24hrs or with imaging evidence of brain damage (eg infarction shown by emboli, thrombosis or low blood flow or haemorrhage)
Initial classification of stroke
- Haemorrhage
- Infarct (ischaemic)
How do we identify vascular territory involved - classification?
- Bamford classification and then with brain imaging
How to classify underlying cause of infarcts?
TOAST classification
Classifying underlying causes of bleeds on brain
- Primary HTN
- Cerebral amyloid angiopathy
- Secondary - eg trauma
Emergency treatment of stroke
- Thrombolysis for ischaemic
- Anticoagulation reversal or neurosurgical intervention for bleeds
Types of strokes
- TACS
- PACS
- LAC
- POCS
What us used to classify the symptoms associated with the types of strokes?
Bamford classification
Worse stroke type prognosis
- TACS - often leave pt with significant weakness
Assessment tools used for rapid assessment of stroke
FAST:
* Face (facial drooping)
* Arm (weakness)
* Speech (slurred)
* Time (call 999)
ROSIER
* Rosier scale used to distinguish between stroke and stroke mimic. commonly used in A&E