Strokes and TIA Flashcards
What are TIAs?
brief episodes of neurological dysfunction resulting from focal cerebral ischemia not associated with permanent cerebral infarction
A TIA is a …
warning sign
8-12% of those with TIA develop a stroke at …
7 days
11-15% of those with TIA develop a stroke at …
one month
TIA epidemiology
46,000 TIA every year in the UK 15% of strokes are preceded by a TIA Risk of stroke following a TIA: 5% - 48 hours 8% - one week 12% - one month 17% - three months
Risk of stroke following a TIA: ...% - 48 hours 8% - one week ...% - one month 17% - three months
5% - 48 hours
8% - one week
12% - one month
17% - three months
The ABCD (2) score
Age >60 years (1)
Blood pressure SBP>140, DBP>90 (1)
Clinical features uni. Weakness (2), speech dis (1)
Duration >60min (2), 10-59 min (1)
Diabetes - yes (1)
Total = 7
0-3 = low risk seen within a week, 4-7 = high risk seen within 24 hours
Now abandoned - low/high risk does not make a difference now
What to do ? (TIA - ABCD (2))
Aspirin 300mg immediately
Specialist assessment within 24 hours
2ry prevention measures introduced
Crescendo TIA (2 or > in a week) = high risk
Stroke
common and devastating condition
Every 5 minutes in the UK someone has a stroke
High mortality
High morbidity
Stroke annual incidence in the UK
100,000 first strokes 30,000 recurrent strokes 500,000 stroke victims in community third most common cause of death most common cause of long-term disability
Definition of stroke
A clinical syndrome characterised by rapidly developing symptoms and/or signs of focal, and at times global, loss of cerebral function with symptoms lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.
Risk factors of stroke (1)
Non modifiable: Age Male sex Family hx Previous stroke Ethnic origin
Risk factors of stroke (2)
Modifiable: Hypertension Diabetes Mellitus Atrial Fibrillation High cholesterol Carotid stenosis Thrombotic tendency Transient ischaemic attacks (TIA) Smoking
Pathophysiology of Stroke (1)
Ischaemia from atherothrombotic occlusion or embolism (85%)
Left atrium in patients with atrial fibrillation
Left ventricle in patients with myocardial infarction or heart failure
Symptoms of Stroke
hemiparesis/monoparesis hemisensory loss hemianopia hemineglect dysphagia squint/double vision vertigo balance and coordination problems altered consciousness dizziness 'confusion' 'off legs' headache vomiting
Signs of stroke on clinical examination
Conscious level Neurological signs Blood pressure Heart rate and rhythm Peripheral pulses
Pathological causes of stroke
Cerebral infarct (80%) Intracerebral haemorrhage (105)
Cerebral circulation
Total anterior circulation syndrome
Partial anterior circulation syndrome
Lacunar syndrome
Posterior circulation syndrome
Symptoms and signs of stroke depend on …
vascular territory involved - OCSP classification
Anterior circulation strokes
Unilateral weakness, unilateral sensory loss or inattention, isolated dysarthria, dysphagia, vision: h. hemianopia, m. blindness, v. inattention
Total Anterior Circulation (TAC)
All of the following: motor or sensory cortical hemianopia
60% dead at 1 year
Lacunar strokes
Motor or sensory signs only
10% dead at 1 year
25% dependant at 1 year
Investigations - Stroke
CT scan head/MRI
ECG
CXR
FBC, ESR, clotting, electrolytes and creatinine, fasting glucose and lipids, urinalysis
Investigations - Stroke (2)
Carotid doppler
Echocardiography - bubble contrast-echo
Thrombophilia screen
Vasculitic screen
Management of stroke - where?
an acute stroke unity
with recovery different needs of care
stroke units offer
Management of stroke - medical treatment
Aspirin 300mg daily for at least 2 weeks
IV fluids - 2L N/S per 24hrs
O2 2l via nasal cannulae
Thrombolysis
Atleplase up to 6 hours from onset of stroke increases significantly the chance of a near complete recovery (IST3 findings) and no upper age limit
Followed by thrombectomy
Neurosurgery
Large cerebellar infarct or bleed
Acute hydrocephalus
Iv mannitol
Craniectomy
Reversal of anticoagulation
Primary intracerebral haemorrhage
Fresh frozen plasma
Vitamin K
Early complications of stroke
Hyperglycaemia BM>12 Hypertension Fever Infarct extension or rebleeding Cerebral oedema, herniation
Late complications of stroke
Aspiration pneumonia UTI DVT PE Incontinence Pressure sores Depression/anxiety Seizures Pain
Rehab - stroke
to restore function and reduce the effect of stroke on patients and carers - should start early
MDT - stroke
Doctor Nurse Physio Occupational therapist Speech and language Social worker dietician more...
Summary of stroke
major cause of death and disability
Incidence increases with age
Hx and exam are key to classification
Understand and use OCSP
Stroke units reduce mortality and dependency
MDT care is critical to success
Research is needed (relevant and meaningful)
