Stroke & TIA

Question 1

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

Answer 1

15%

Question 2

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

Answer 2

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

Question 3

What are crescendo TIAs?

Answer 3

2 or more consecutive TIAs in < 24 hours

Question 4

What is meant by stroke?

Answer 4

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

Question 5

What % of strokes are ischaemic?

Answer 5

85%

Question 6

What are the 2 types of ischaemic stroke?

Answer 6

Thrombotic - spontaneous thrombus in situ

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

Question 7

What are the 2 types of haemorrhagic stroke?

Answer 7

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

Question 8

When does amaurosis fugax occur?

What is it?

Answer 8

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

More common in TIA

Question 9

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

Answer 9

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

Question 10

What are general features of stroke?

Answer 10

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

Question 11

A cerebral infarct would exhibit which symptoms?
ACA
MCA
PCA

Answer 11

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

Question 12

A brainstem infarct would exhibit which symptoms?

Answer 12

Quadraplegia
Locked in syndrome
Visual disturbance

Question 13

A lacunar infarct would exhibit which sx?

Answer 13

Ataxic hemiparesis
Dysarthria
Clumsy hand
Cognition still in tact

Question 14

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

Answer 14

<1 hour

Question 15

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

Answer 15

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

Question 16

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

Answer 16

Haemorrhagic - white

Ischaemic - dark

Question 17

What is the acute management of ischaemic stroke?

Answer 17

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

Question 18

What further management would occur with severe MCA infarct?

Answer 18

Surgical referral for decompressive hemicraniectomy

Question 19

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

Answer 19

4 months

Question 20

What is the acute management of a TIA?

Answer 20

Aspirin 300mg stat

Question 21

What assessment is used to determine risk after TIA?

Answer 21

ABCD2 score

Assesses 7 day risk of having a stroke

Question 22

What is alteplase?

Answer 22

a tissue plasminogen activator (tPA)

Breaks down blood clots

Question 23

What are the components of ABCD2

Answer 23

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

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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

Urgent MRI within 24 hours + same day carotid USS

Question 26

Name 3 TIA differentials?

Answer 26

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

Question 27

What should a statin be prescribed after stroke?

Answer 27

48 hours later, not before