Stroke + TIA Flashcards
S+S brainstem stroke
Quadriplegia
Locked in
S+S lacunar stroke + what is it
Occurs secondary to small vessel disease (atherosclerosis), involves subcortical stroke:
Pure motor
Pure sensory
Ataxic hemiparesis
Usually associated with HTN
Small infarcts around basal ganglia, internal capsule, thalamus + pons
S+S total + partial anterior circulation infarct
All 3 = TACS, 2 = PACS:
Unilateral weakness and/ or sensory disturbance of face, arm + leg
Homonymous hemianopia
High cerebral dysfunction eg dysphasia, visuospatial disorder
Posterior circulation syndrome S+S
1 present to be POCS:
Cranial nerve palsy + contralateral deficit
Bilateral motor/ sensory deficit
Conjugate eye movement disorder (horizontal gaze palsy)
Cerebellar dysfunction: ataxia, vertigo, nystagmus Isolated
homonymous hemianopia
Investigation + management of stroke (acute)
CT head within 4 hours to exclude haemorrhage
If no evidence of haemorrhage, given alteplase within 4.5 hrs. If over 4.5 hrs, 300mg aspirin (rectal if NBM)
Repeat CT head at 24 - 48 hrs
Bloods, BM, MRI (24 - 48 hrs later), carotid Duplex USS (for ischaemic strokes)
Keep BP (IV infusion of GTN or labetaolol), BM + O2 controlled
Sip test - spoon of water, then cup, then add thickener - if not, NBM + NG tube
S+S carotid TIA
Unilateral motor/ speech difficulty
Loss of vision
S+S vertebrobasilar TIA
Bilateral visual defects
Vomiting
Vertigo
Dysphagia
ataxia
Investigations and treatment of TIA (long term)
ECG, echo, carotid USS, CT within a week
Aspirin 300mg then clopidogrel + statin
HTN management
Types of ischaemic stroke
Embolism
Thrombosis - blood clot forming locally
Systemic hypoperfusion due to hypotension
Cerebral venous sinus thrombosis
Types of haemorrhagic stroke
Intracerebral haemorrhage, intraventricular, SAH
Extradural - egg shaped
Subdural - slithers around the side like a snake
What is the Bamford classification?
Classification for ischaemic strokes
Also called Oxford system
TACS, PACS, POCS, LACS
What is the ABCD2 score?
Assess risk of stroke in 90 days after TIA
Age >60
BP >140/90
Clinical features of TIA (unilateral weakness = 2, speech disturbance = 1)
Duration >60 mins = 2, 10-59 mins = 1
Diabetes
Score >4 = give aspirin 300mg + specialist assessment within 24 hrs
Management of stroke (long term)
Aspirin for first 14 days (300mg) + then switch to clopidogrel 75mg lifelong
Statin
HTN management (ACD rule)
Carotid endarteterecomy
warfarin/ NOAC if AF, + digoxin/ B blocker if needed
What to do with a high INR?
>5/6 + any bleed = vit K (oral phytomenodione)
>8 = vit K
Monitoring of warfarin
Yearly FBC
Stable INR = checks every 12 weeks
What affects warfarin dose?
Alcohol Leafy green veg - cause low INR
Abx, steroids (make INR go up)
Monitoring with NOACS
FBC, LFTs, coag check + INR baseline
FBC + LFTs yearly
RF for ischaemic stroke
Carotid stenosis , AF, valve disease, atherosclerosis
CVD RF (smoking, HTN, DM, alcohol (ETOH))
COCP
Polycythaemia vera (production of more Hb + RBC)
Comparison of ischaemic vs haemorrhagic stroke on CT scan
Haemorrhagic - white blood
Ischaemic = delayed response in brain
Causes of extra + subdural haemorrhages + likely patients + presentation?
Extradural = usually in young patients, due to head strike. Have lucid interval but then lose consciousness over few hours. Damage to middle meningeal artery or vein
Subdural = due to falls, no obvious cause - commonly in elderly + drunks - venous bleeding so presents slowly. Can be acute, subacute (3-7 days) or chronic (2-3 weeks)
What is the circle of willis?
Connecting arteries in brain
What are the cerebellar signs?
DANISH P
Dysdiadokinesis
Ataxia
Nystagmus
Intention tremor
Slurred speech
Homonymous hemianopia
Past pointing
SAH presentation + RF
Sudden onset thunderclap headache, typically pulsates towards occiput
Can vomit or LOC
RF: berry aneurysms
Star shape on CT
What is a carotid endarterectomy?
Removing debris if carotid artery is stenosed (50-70% lumen occluded)
What is alteplase, what are the CI?
t-PA
CI: <18, >80, onset of symptoms >4 hrs, seizures, neuro signs resolved, fully dependant on carers
Management of haemorrhagic stroke
Neurosurgery - clipping + coiling
Vasospasm is common complication so give nimodepine
Control HTN with infusions
Causes of emboli from the heart
AF
MI
Endocarditis
Valvular disease
Dilated cardiomyopathy
Left heart myxoma
Prosthetic valves
