Stroke/ TIA Flashcards
What is a stroke?
cerebrovascular accident (CVA).
Cerebrovascular accidents are either:
Ischaemia or infarction of brain tissue secondary to inadequate blood supply
Intracranial haemorrhage
How id blood supply to the brain disrupted?
Thrombus formation or embolus, for example in patients with atrial fibrillation
Atherosclerosis
Shock
Vasculitis
What is a TIA?
transient neurological dysfunction secondary to ischaemia without infarction.
Transient ischaemic attacks often precede a full stroke. A crescendo TIA is where there are two or more TIAs within a week. This carries a high risk of developing in to a stroke.
Presentation?
In neurology, suspect a vascular cause where there is a sudden onset of neurological symptoms.
Stoke symptoms are typically asymmetrical:
Sudden weakness of limbs
Sudden facial weakness
Sudden onset dysphasia (speech disturbance)
Sudden onset visual or sensory loss
Risk Factors?
Cardiovascular disease such as angina, myocardial infarction and peripheral vascular disease
Previous stroke or TIA
Atrial fibrillation
Carotid artery disease
Hypertension
Diabetes
Smoking
Vasculitis
Thrombophilia
Combined contraceptive pill
Fast tool?
for Identifying a Stroke in the Community
F – Face
A – Arm
S – Speech
T – Time (act fast and call 999)
Rosier tool?
Recognition Of Stroke In Emergency Room
ROSIER is a clinical scoring tool based on clinical features and duration. Stroke is likely if the patient scores anything above 0.
Management of stroke?
Admit patients to a specialist stroke centre
Exclude hypoglycaemia
Immediate CT brain to exclude primary intracerebral haemorrhage
Aspirin 300mg stat (after the CT) and continued for 2 weeks
Thrombolysis with alteplase can be used after the CT brain scan has excluded an intracranial haemorrhage.
Thrombectomy (mechanical removal of the clot) may be offered if an occlusion is confirmed on imaging, depending on the location and the time since the symptoms started. It is not used after 24 hours since the onset of symptoms.
Stroke rehabilitation
Management of TIA
Start aspirin 300mg daily. Start secondary prevention measures for cardiovascular disease. They should be referred and seen within 24 hours by a stroke specialist.
Specialist Imaging
Diffusion-weighted MRI is the gold standard imaging technique. CT is an alternative.
Carotid ultrasound can be used to assess for carotid stenosis. Endarterectomy to remove plaques or carotid stenting to widen the lumen should be considered if there is carotid stenosis.
Secondary Prevention of Stroke
Clopidogrel 75mg once daily (alternatively dipyridamole 200mg twice daily)
Atorvastatin 80mg should be started but not immediately
Carotid endarterectomy or stenting in patients with carotid artery disease
Treat modifiable risk factors such as hypertension and diabetes
