Stroke & TIA Flashcards

1
Q

What % of people who have a stroke have a preceding TIA?

A

15%

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2
Q

What is meant by TIA, and what is the duration of symptoms?

A

Acute and temporary loss of cerebral/ ocular functions due temporary occlusion of cerebral artery
Lasts < 24 hours, usually <30 minutes

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3
Q

What are crescendo TIAs?

A

2 or more consecutive TIAs in < 24 hours

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4
Q

What is meant by stroke?

A

Clinical syndrome caused by cerebral infarction or haemorrhage
Causing rapidly developing signs of focal & global disturbances
Lasts >24 hours or leads to death

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5
Q

What % of strokes are ischaemic?

A

85%

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6
Q

What are the 2 types of ischaemic stroke?

A

Thrombotic - spontaneous thrombus in situ

Embolic - clot breaks off from larger artery (e.g. carotid)

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7
Q

What are the 2 types of haemorrhagic stroke?

A

Intracerebral - bleeding from vessel within brain tissue (e.g due to htn)
Subarachnoid - blood vessels burst and cause bleeding between surface & subarachnoid tissues

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8
Q

When does amaurosis fugax occur?

What is it?

A

Emboli lodges in retinal artery, can cause progressive unilateral loss of vision
‘like curtain coming down’

More common in TIA

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9
Q

Which is the most common artery to be affected in ischaemic stroke?

A

Cerebral intact - 50%
Brainstem infant - 25%
Lacunar infant - 25%

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10
Q

What are general features of stroke?

A

Ipsilateral facial palsy
Contralateral weakness/ paralysis & sensory loss
Dysphasia
Hemianopia (if optic radiation)

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11
Q

A cerebral infarct would exhibit which symptoms?
ACA
MCA
PCA

A

ACA - contralateral weakness + facial sparing
MCA - contralateral hemiparesis, contralateral homonymous hemianopia, dysphagia
PCA - contralateral homonymous hemianopia + macula sparing

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12
Q

A brainstem infarct would exhibit which symptoms?

A

Quadraplegia
Locked in syndrome
Visual disturbance

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13
Q

A lacunar infarct would exhibit which sx?

A

Ataxic hemiparesis
Dysarthria
Clumsy hand
Cognition still in tact

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14
Q

When should a CT/MRI be conducted is stroke is suspected?

A

<1 hour

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15
Q

When should a CT be be urgently requested if someone is presenting with stroke?

A

GCS <13
Risk o bleeding - on oral anticoagulants/ bleeding disorder
Severe headache on onset of stroke
Evidence of raised ICP

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16
Q

How would a haemorrhagic stroke look compared to an ischaemic stroke on CT?

A

Haemorrhagic - white

Ischaemic - dark

17
Q

What is the acute management of ischaemic stroke?

A

Thrombolysis with alteplase - within 4.5 hours
Aspirin 300mg ASAP + for 2 weeks
Then lifelong clopidogrel/ anti-coagulation

18
Q

What further management would occur with severe MCA infarct?

A

Surgical referral for decompressive hemicraniectomy

19
Q

How long must someone not drive for following a stroke/TIA?

A

4 months

20
Q

What is the acute management of a TIA?

A

Aspirin 300mg stat

21
Q

What assessment is used to determine risk after TIA?

A

ABCD2 score

Assesses 7 day risk of having a stroke

22
Q

What is alteplase?

A

a tissue plasminogen activator (tPA)

Breaks down blood clots

23
Q

What are the components of ABCD2

A

A - age ≥60 = 1
B - BP at presentation ≥140/90 = 1
C - clinical features - unilateral weakness = 2; speech disturbance with no weakness = 1
D - duration of sx = ≥ 60 mins = 2; 10-59 mins = 1
D - diabetes =1

24
Q

What is a significant ABCD2 score and what is the management?

A

≥ 4
considered high risk of an early stroke - neuro assessment
Urgent MRI within 24 hours
Asprin 300mg + clopidogrel 300mg then 75mg

25
Q

What determines someone as high risk for early stroke after TIA?
What is the management?

A

ABCD2 score of ≥ 4
Crescendo TIAs
TIA whilst on anticoagulant
AF

Urgent MRI within 24 hours + same day carotid USS

26
Q

Name 3 TIA differentials?

A

Migraine with aura - would be gradual rather than sudden
Hypoglycaemia - can mimic stroke - check glucose
Focal seizure - stiff limb rather than limp

27
Q

What should a statin be prescribed after stroke?

A

48 hours later, not before