Stroke/TIA (transient ischaemic attack)

Question 1

Stroke definition

Answer 1

A syndrome of rapid onset of neurological deficit caused by focal, cerebral, spinal, or retinal infarction

Occurs when a blood vessel to the brain ruptures and bleeds, or when there’s a blockage in the blood supply to the brain.

Ischaemic stroke:
– arterial disease and atherosclerosis are the main pathological processes causing stroke

Hemorrhagic stroke:
– caused by a leaking blood vessel that seeps into the brain.

Question 2

Stroke Aetiology

Answer 2

Ischaemic stroke (87%):
– arterial disease and atherosclerosis are the main pathological processes causing stroke. Caused by the blockage of atherosclerosis of an artery.

—- cerebral embolism- occurs when a blood clot forms in another part of the body- often the heart of arteries in the upper chest or neck. This clot will move through bloodstream until it gets stuck on an artery too narrow, meaning it will get stuck causing a stroke.

—- cerebral thrombosis- when a blood clot develops at the fatty plaque within the blood vessel.

Hemorrhagic stroke:
– caused by a leaking blood vessel that seeps into the brain

—- intracerebral haemorrhage- causes approx 10% of strokes, when the tissues surrounding the brain fill with blood after an artery bursts.
can be caused by:
- hypertension
- cerebral amyloid angiopathy

—- subarachnoid haemorrhage- spontaneous arterial bleeding into the subarachnoid space, usually clearly seen clinically due to its dramatic onset.
caused by:
- saccular aneurysms (70%)
- arteriovenous malformation (10%)

Question 3

Stroke epidemiology

Answer 3

Leading cause of death in high-income countries

Question 4

Stroke risk factors

Answer 4

Obesity
Age
Smoking
Sedentary lifestyle
Genetic/ethnic
Hypertension (most modifiable)

Question 5

Stroke clinical presentation

Answer 5

Paralysis
Numbness or weakness in the arm, face and leg, especially on one side of the body

Slurred speech

Trouble speaking or understanding others

Trouble walking

Dizziness

Seizures

Nausea or vomiting

Severe, sudden headache without a known cause

Question 6

TIA definition

Answer 6

Temporary period of symptoms similar to those of a stroke. Usually only lasts a few minutes and doesn’t cause permanent damage.

Often called a ‘mini stroke’, and may be a warning for a future stroke.

Question 7

TIA aetiology

Answer 7

Same origins as an ischaemic stroke.
Unlike a stroke however, the blockage in a TIA is brief.

Underlying cause is atherosclerosis or high blood pressure

Question 8

TIA epidemiology

Answer 8

1 in 3 people who have a TIA will eventually have a stroke

Question 9

TIA risk factors

Answer 9

family history

age

smoking

prior TIA

sickle cell disease

Question 10

TIA clinical presentation

Answer 10

Usually lasts a few minutes

most symptoms disappear within an hour, though rarely symptoms last up to 24 hours.

– weakness, numbness or paralysis in the face, arm, or leg, especially on one side of the body
– slurred or garbled speech or difficulty understanding others
– vertigo or loss of balance or coordination