Stroke & TIA Flashcards
What % of people who have a stroke have a preceding TIA?
15%
What is meant by TIA, and what is the duration of symptoms?
Acute and temporary loss of cerebral/ ocular functions due temporary occlusion of cerebral artery
Lasts < 24 hours, usually <30 minutes
What are crescendo TIAs?
2 or more consecutive TIAs in < 24 hours
What is meant by stroke?
Clinical syndrome caused by cerebral infarction or haemorrhage
Causing rapidly developing signs of focal & global disturbances
Lasts >24 hours or leads to death
What % of strokes are ischaemic?
85%
What are the 2 types of ischaemic stroke?
Thrombotic - spontaneous thrombus in situ
Embolic - clot breaks off from larger artery (e.g. carotid)
What are the 2 types of haemorrhagic stroke?
Intracerebral - bleeding from vessel within brain tissue (e.g due to htn)
Subarachnoid - blood vessels burst and cause bleeding between surface & subarachnoid tissues
When does amaurosis fugax occur?
What is it?
Emboli lodges in retinal artery, can cause progressive unilateral loss of vision
‘like curtain coming down’
More common in TIA
Which is the most common artery to be affected in ischaemic stroke?
Cerebral intact - 50%
Brainstem infant - 25%
Lacunar infant - 25%
What are general features of stroke?
Ipsilateral facial palsy
Contralateral weakness/ paralysis & sensory loss
Dysphasia
Hemianopia (if optic radiation)
A cerebral infarct would exhibit which symptoms?
ACA
MCA
PCA
ACA - contralateral weakness + facial sparing
MCA - contralateral hemiparesis, contralateral homonymous hemianopia, dysphagia
PCA - contralateral homonymous hemianopia + macula sparing
A brainstem infarct would exhibit which symptoms?
Quadraplegia
Locked in syndrome
Visual disturbance
A lacunar infarct would exhibit which sx?
Ataxic hemiparesis
Dysarthria
Clumsy hand
Cognition still in tact
When should a CT/MRI be conducted is stroke is suspected?
<1 hour
When should a CT be be urgently requested if someone is presenting with stroke?
GCS <13
Risk o bleeding - on oral anticoagulants/ bleeding disorder
Severe headache on onset of stroke
Evidence of raised ICP
How would a haemorrhagic stroke look compared to an ischaemic stroke on CT?
Haemorrhagic - white
Ischaemic - dark
What is the acute management of ischaemic stroke?
Thrombolysis with alteplase - within 4.5 hours
Aspirin 300mg ASAP + for 2 weeks
Then lifelong clopidogrel/ anti-coagulation
What further management would occur with severe MCA infarct?
Surgical referral for decompressive hemicraniectomy
How long must someone not drive for following a stroke/TIA?
4 months
What is the acute management of a TIA?
Aspirin 300mg stat
What assessment is used to determine risk after TIA?
ABCD2 score
Assesses 7 day risk of having a stroke
What is alteplase?
a tissue plasminogen activator (tPA)
Breaks down blood clots
What are the components of ABCD2
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
What is a significant ABCD2 score and what is the management?
≥ 4
considered high risk of an early stroke - neuro assessment
Urgent MRI within 24 hours
Asprin 300mg + clopidogrel 300mg then 75mg
