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Acute Medicine > Stroke + TIA > Flashcards

Stroke + TIA Flashcards

1
Q

Two types of stroke?

A

Haemorrhagic

Ischaemic

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2
Q

Features of cerebral hemisphere stroke?

A

Hemiplegia: flaccid and then spastic

Sensory loss

Homonymous hemianopia

Dysphasia

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3
Q

What could help you distinguish between haemorrhagic and ischaemic stroke?

A

Not easy

Haem: meningism (fever, neck stiffness), severe headache, progressive symptoms, reduced consciousness,

Isch: carotid bruit, AF, prev TIA

CT scan!

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4
Q

Risk factors for ishcaemic stroke?

A

Family Hx

Smoking
Alcohol
Obesity
Hyperlipidaemia
Sedentary

Diabetes
Hypertension
Ischaemic heart disease
Peripheral artery disease

AF
Other cardiac arrhythmias
Valvular heart disease

Polycythaemia vera
Clotting disorders

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5
Q

Risk factors for haemorrhagic stroke?

A

Aneurysms: Berry
Links with PKC, Von Hippel Lindau

Bleeding disorder

Drugs: warfarin, NOACs, clopidogrel, LMWH

Hypertension?

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6
Q

Features of posterior circulation stroke?

A

Motor deficits: ataxia, clumsiness, paralysis

Homonymous hemianopia
Diplopia

Vertigo

Dysphasia, dysarthria

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7
Q

Features of brainstem infarct?

A

Locked in syndrome

Quadriparesis

Loss of speech

Reduced consciousness

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8
Q

What is a lacunar infarct?

Features?

A

Small infarct around brainstem, internal capsule, thalamus and pons

Consciousness and cognition intact

Motor and/or sensory signs
Ataxia

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9
Q

Differential of stroke?

A

TIA

Hypoglycaemia

Hemiplegic migraine

Bell’s palsy

SOL, tumour

Todd’s paralysis following a seizure

Drug overdose

Giant cell arteritis

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10
Q

If a patient presents with sudden onset neurology symptoms, what is a cause that could be treated really quickly?

A

Hypoglycaemia

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11
Q

Investigations of stroke?

A

CT head ASAP to see if ischaemic or haemorrhagic

Bloods: FBC, U+E, clotting, LFT, lipids

BMs

ECG: look for AF

Echo: to see if its a post MI infarct

Carotid doppler USS

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12
Q

Acute management of ischaemic stroke?

A

ABCDE

Thrombolysis with alteplase if within 4.5 hours

Then treat with aspirin 24 hours later for life
Or use clopidogrel as second choice

Supportive: stabilise BP, blood glucose etc.

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13
Q

Acute management of TIA?

A

Aspirin

If intolerant, clopidogrel

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14
Q

What’s a TIA?

A

Transient ischaemic attack

Episode of neurological dysfunction

Ischaemia but not infarction
Symptoms fully resolved within 24 hours

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15
Q

How would you calculate a person’s risk of having a stroke following a TIA?

A

ABCD2

Age over 60 (1)

Blood pressure over 140/90 (1)

Clinical features:

  • unilateral weakness (2)
  • Speech dist, no weakness (1)
  • Other (0)

Duration:

  • 60 mins + (2)
  • 10-59 mins (1)
  • less than 10 (0)

Diabetes (1)

A score over 4 = high risk

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16
Q

Long term management of a TIA and stroke?

Remember there’s a difference with AF and non-AF

A

Non-AF:
Clopidogrel
If CI or not tolerated: aspirin + dipyridamole

AF: consider warfarin or NOAC

For both

Statin 48 hours after onset

Hypertension treatment if needed

Lifestyle modification

17
Q

Acute management of haemorrhagic stroke?

A

Stop/reverse anti-coagulant

Surgical intervention: remove haematoma and relieve raised ICP

18
Q

Long term management of haemorrhagic stroke?

A

Control BP

Supportive

19
Q

What’s the risk score to calculate risk of stroke with AF?

A

CHA2DS2VASC

CCF (1)
Hypertension (1)
Age: 75+ (2), 65-75 (1)
Diabetes (1)
Stroke/TIA/VTE (2)
VAscular disease
Sex female (1)
20
Q

How would you assess the risk of a major bleed in a patient on anti-coagulants for AF?

A

HAS BLED

Hypertension (1)
Abnormal renal/liver (1 each)
Stroke (1)

Bleeding tendency (1)
Labile INR (1)
Elderly (over 65) (1)
Drugs: NSAIDs, aspirin, alcohol (1 each)

3 or more = high risk of bleed

21
Q

Significance of low or high INR?

Target INR range for AF?
Mechanical heart valve?

A

Higher = more thin blood

Allowed 0.5 either side of target

AF:
target = 2.5
range = 2.0-3.0

Mech heart valve:
target = 3.5
range = 3.0-4.0

Acute Medicine (15 decks)

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