Strokes and TIA

Question 1

Definition

Answer 1

A stroke is a serious life threatening condition that occurs when blood supply to a part of the brain is cut off

TIA has similar features to a stroke but resolves in 24 hours

Question 2

Risk Factors (11)

Answer 2

smoking, alcohol, drugs, HTN, AF, old age, high cholesterol, diabetes, oral contraceptives

Question 3

Presentation

Answer 3

Confusion
dysphasia
syncope
sudden transient loss of vision in one eye
cranial nerve defects
headache
sensory loss
homonymous hemianopia
diplopia
vertigo (stroke)
nausea
Horner’s Syndrome, unilateral weakness.

Question 4

Types of Stroke (5)

Answer 4

Ischaemic – due to infarction following vascular occlusion or stenosis

Haemorrhagic – collection of blood within brain parenchyma, ventricular system or subarachnoid space NOT following trauma

Carotid Artery Dissection - blood enters arterial walls and occludes it

Dural venous sinus thrombosis

Hypoxic brain injury

Question 5

Examinations

Answer 5

FAST – facial weakness, arm or leg weakness, speech disturbance

Question 6

Investigations (3)

Answer 6

CT Imaging – can only see a while after stroke has occurred

MRIs show more acutely

Check blood glucose to rule out hypoglycaemia (less than 3.3mmol/L)

Question 7

Management for TIA and Stroke

Answer 7

Immediate admission for TIA or Stroke

For TIA – aspirin 300mg, if already taking regular aspirin then continue. Then refer to TIA outpatient clinic.

For stroke – Anticoagulants or thrombolysis DO NOT start anticoagulation or antiplatelets until intracerebral haemorrhage has been ruled out by CT or MRI.

Question 8

Complications (4)

Answer 8

Infection (aspiration pneumonia)

Delirium

Cardiac complications

Mobility issues, sensory problems, incontinence, pain, fatigue , dysphagia, ED, visual impairment, depression

Question 9

Differentials (5)

Answer 9

Hypoglycaemia

Drug and alcohol toxicity

Vertigo, Meniere’s disease, labyrinthitis

MS

Bells Palsy