Stroke/TIA

Question 1

Define stroke

Answer 1

Rapid onset of neurological deficit due to vascular lesion leading to central nervous tissue infarct. >24h

Question 2

RF stroke

Answer 2

1. HTN
2. Age
3. Previous stroke/TIA
4. DM
5. FH
6. Male
7. Hypercholesterolaemia
8. AF
9. Carotid stenosis
10. Alcohol, smoking

Question 3

Types of stroke

Answer 3

1. Ischaemic stroke (80%)

2. Haemorrhagic stroke - mostly likely rupture of Charcot-Bouchard aneurysm

Question 4

Signs and symptoms of cerebral stroke
ACA (5)
MCA (4)
PCA (5)

Answer 4

ACA:
1. Lower limb paraparesis and loss of sensation
2. Gait apraxia
3. Incontinence
4. Drowsiness
5. Akinetic mutism
MCA:
1. Upper limb paraparesis and loss of sensation
2. Hemianopia
3. Facial droop
4. Aphasia/dysphasia
PCA:
1. Hemianopia
2. Cortical blindness
3. Agnosia - unable to process sensory info
4. Dyslexia
5. Unilateral headache

Question 5

Investigations for stroke (4)

Answer 5

1. FAST - facial droop, arm weakness, speech difficulty, time to call 999
2. CT/MRI head - check for embolism
3. Carotid doppler USS
4. Bloods - FBC, ESR, clotting, glucose, lipids

Question 6

Management of stroke

Answer 6

Ischaemic:
1. IV alteplase (4.5h) + 300mg aspirin
2. Aspirin 300mg 2wks -> clopidogrel 75mg 
Haemorrhagic:
1. B-blockers/ARB
2. Beriplex if warfarin related

Question 7

Prevention of stroke

Answer 7

1. Lifestyle change - smoking cessation, low fat + salt diet, exercise
2. BP control - b-blockers
3. Statins
4. AF - antiplatelets

Question 8

Define TIA

Answer 8

Transient Ischaemic Attack - vascular lesion causing neurological deficit lasting < 24h. Usually completely reversible

Question 9

Causes of TIA

Answer 9

1. Atherothromboembolism - usually from carotids
2. Cardioembolism - mural thrombi post MI, AF emboli
3. Hyperviscosity - polycythaemia, sickle-cell, myeloma
4. Vasculitis

Question 10

Risk score for stroke following TIA

Answer 10

A - age 60+
B - BP >140/90
C- clinical features - unilateral weakness (2 points), speech difficulty w/o weakness (1 point)
D - duration 60min (points) <60 mins (1 point)
D - Diabetes Mellitus

Question 11

High risk of stroke

Answer 11

1. 4+ on ABCD2
2. AF (CHA2DS2-VASc > 1)
3. > 1 TIA in a week
4. TIA on anticoagulant

Question 12

CHA2DS2VASc

Answer 12

Atrial fibrillation stroke risk
Congestive heart failure 1pt
Hypertension 1pt
Age 75+ 2pt
Diabetes 1pt
Stroke,TIA 2pt
Vascular disease 1pt
Age 65-74 1pt
Sex category (female) 1pt

Question 13

Signs and symptoms of TIA (5)

Answer 13

1. Amaurosis fugax - ‘curtain coming down’ occlusion of retinal artery
2. Hemiparesis
3. Hemisensory loss
4. Aphasia
5. Global events not typical (syncope, dizziness)

Question 14

Investigations for TIA (4)

Answer 14

1. CT/MRI
2. ECG+echo
3. Carotid doppler USS
4. Bloods - FBC, U&E, ESR

Question 15

Management of TIA (4)

Answer 15

1. Control CVD risk - BP, statins, DM, stop smoking
2. Antiplatelets - aspirin 300mg 2wks -> clopidogrel 75mg
3. Carotid endarterectomy
4. Driving prohibited 1 month