Stroke + TIA + Facial Nerve palsy Flashcards
What is a TIA
A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction
When is Aspirin in a stroke contraindicated
- Patient has a bleeding disorder
- Patient is on an anti-coagulant
- Patient is already taking a low dose aspirin (cont until specialist review)
- Aspirin is contraindicated
What do you do if TIA has occurred in the last 7 days
- Aspirin 300mg
- Urgent assessment from a stroke physician in 24 hours
- safety net
- Don’t drive
What do you do if TIA has occurred 7 days ago
- Assessment from a stroke physician within 7 days
- Safety net
- Don’t drive
Anti-thrombotic therapy used in Ischaemic stroke
- clopidogrel
2. second line aspirin + dipyridamole
When is carotid endartectomy indicated
- stroke or TIA in the carotid territory and are not severely disabled
- carotid stenosis > 70% according ECST* criteria or > 50% according to NASCET** criteria
What is Bells Palsy
acute, unilateral, idiopathic, facial nerve paralysis
20-40 years old, more common in pregnant women
Key features of Bells Palsy
- lower motor neuron facial nerve palsy - forehead affected
- post-auricular pain (may precede paralysis)
- altered taste
- dry eyes
- hyperacusis
Management of Bells Palsy
- prednisolone 1mg/kg for 10 days within 72 hours of onset
- artificial tears and lubricants
Symptoms of a stroke
Symptoms usually asymmetrical Sudden weakness of limbs Sudden facial weakness Sudden onset dysphasia (speech disturbance) Sudden onset visual or sensory loss
Risk factors for stroke
Cardiovascular disease: angina, MI and PVD Previous stroke or TIA Atrial fibrillation Carotid artery disease Hypertension Diabetes Smoking Vasculitis Thrombophilia Combined contraceptive pill
What tool is used to identify stroke
F – Face
A – Arm
S – Speech
T – Time (act fast and call 999)
What is the ABCD2 Score
The ABCD2 score is used for assessing patients with a suspected TIA to estimate their risk of subsequently having a stoke. A higher score suggests a higher risk of stroke within the following 48 hours.
What does the ABCD2 score assess
A – Age (> 60 = 1)
B – Blood pressure (> 140/90 = 1)
C – Clinical features (unilateral weakness = 2, dysphasia without weakness = 1)
D – Duration (> 60 = 2, 10 – 60 = 1, < 10 = 0)
D – Diabetes = 1
What is the acute management of stroke
- Admit patients to a specialist stroke centre
- Exclude hypoglycaemia
- Immediate CT brain to exclude primary intracerebral haemorrhage
- Aspirin 300mg stat (after the CT) and continued for 2 weeks
- Thrombolyse: alteplase
What is alteplase
- tissue plasminogen activator that rapidly breaks down clots and can reverse the effects of a stroke if given in time
- Needs to be given within 4.5 hours of onset
- Patients need monitoring for post thrombolysis complications such as intracranial or systemic haemorrhage
What is the Management of a TIA
- aspirin 300mg daily
- Atorvostatin 80mg
- Seen by stroke physician within 24 hours, esp. if crescendo