Strokes, TIAs and Neurological Focal Attacks Flashcards
What are the key characteristics of a TIA
- why does this happen?
- what are the other non specific symptoms that may also arise
ACUTE, SUDDEN LOSS of FOCAL MONO MOTOR/OCULAR function
- last less than 24hrs
- thrombosis/embolism => inadequate supply
faint, dizzy, syncope, drop attacks
confusion
incontinence
What are the key characteristics of migraine with aura
-what demographic is this more common in
POSITIVE MARCHING, in MINUTES
- homonymous/unilateral/central visual symptoms that build
- flashes, zigzag
- marching up limbs
- transition from paresthesia, visual, dysphagia without delay
Young females
What are the key characteristics in epilepsy
FOCAL, ACUTE with POSITIVE sensory/motor SPREAD in a minute
-attacks are all the same
What are the key characteristics of transient global amnesia
-what demographic is this more common in
SHORT TERM ACUTE ANTEROGRADE, RETROGRADE AMNESIA that resolves after hours
Middle age, elderly
Describe how you could reduce the recurrence/occurence of strokes and TIAs in the carotid
Carotid endarterectomy
Carotid stenosis found via USS
-plaque removed surgically
How would you manage
- suspected TIAs
- past TIAs
- carotid stenosis
Where is the best place for these patients
Suspected
-300mg aspirin, seen by specialist, MRI
Past TIAs or carotid stenosis
-seen/operated on within wk
Stroke units
- assessed, monitored
- MDT rehab and discharge plan => better outcomes
How would you address the cause of the TIA/stroke
What is vital in this
What would you do if these procedures weren’t appropriate/successful?
IV thrombosis => open blocked vessel, stop progression of infarct
TIME IS BRAIN
If you can
- see the clot
- marked neuro deficit => endovascular thrombectomy via femoral artery
Hemicranietomy
- relieve pressure
- prevent contralateral compression
How could you manage an intracerebral hemorrhage
-3 ways
BP control => reduce expansion
Anticoagulation
Early surgery
What are the possible complications of a stroke/TIA
How would you reduce this risk
Reduce DVT, PE with pneumatic leg compressions
Describe the relative CT densities in the brain
Black -air -water, CSF -white -grey -blood -contrast -bone White
Describe how you would use the ABBCS structure to analyze a CT scan
Asymmetry
Blood
- grey, white differentiation
- hyperdensity
- acute blood, bone, contrast, tumor, foreign body
- hypodensity
- edema, infarct, air, tumour
CSF space
- cisterns
- ventricles
- sulci
Skull/scalp
- soft tissue swelling
- fracture
What are the main key features of subarachnoid bleeds
What are the likely causes
What would you see on the CT
Sudden thunderclap headache
- trauma
- rupture of intracranial aneurysm/AVM
Arterial blood fills CSF, ventricles => white star
What are the main key features of extradural bleeds
What are the likely causes
What would you see on the CT
Headache Papilloedema (pressure behind eye) Drowsy, BS failure Coma, death -trauma with # (air, soft tissue swelling)
Arterial blood =>rapid increase in ICP
- midline shift
- LENTIFORM, BICONVEX
What are the main key features of subdural bleeds
What are the likely causes
What would you see on the CT
Confusion, varying consciousness
-often days after initial trauma
Venous bleed =>slow increase in ICP
- mass effect => obstructive hydrocephalus, midline shift, compression
- clots become hypotense with time as they decompose
- CRESCENT
What are the main key features of a hyperacute stroke on a CT
What is the timeframe
Hyperacute (<6hrs)
- no GW differentiation
- loss of lentiform nucleus
- loss of insular ribbon
- hyperdense vessels
- loss of sulci
