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ENT, neuro, eyes > TIA > Flashcards

TIA Flashcards

1
Q

What offer to someone with suspected TIA?

A

Offer aspirin 300mg immediately unless contraindicated

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2
Q

What is first line investigation for TIA?

A

CT to exclude haemorrhage

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3
Q

What is a TIA?

A

Transient - less than 24 hours - neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia, without evidence of acute infarction. Most resolve within one hour

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4
Q

Intracerebral bleed vs subarrach causes

A

IC bleeds occur due to diseases affecting small cerebral vessels eg HPTN
SAH - aneurysms, AV malformations, dissections, anticoags etc

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5
Q

Conditions risk factors for stroke

A

Migraine
Hyperlipidaemia.
Diabetes mellitus.
Sickle cell disease.
Haemophilia.
Antiphospholipid syndrome and other hypercoagulable disorders.
Chronic kidney disease.
Ehlers-Danlos syndrome.
Marfan syndrome.
Pseudoxanthoma elasticum.
Polycystic kidney disease.
Neurofibromatosis type I.
Obstructive sleep apnoea
Vascular malformations
Peripheral vascular disease
Establisjed cardiovascular disease

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6
Q

Early complications of stroke

A

HAEMORRHAGIC TRANSOFRMATION
Cerebral oedema
Delirium
Seizures
Venous throboembolism -> PE
Cardiac complications - MI, HF, AF, arrhythmias
Infection

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7
Q

Mobility problems after stroke

A

Hemiparesis or plegia
Atacia
Falls
Spasticity and contractures
Loss/altered sensation

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8
Q

Why pain after stroke long term?

A

MSK - abnormal positioning etc
Neuropathic

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9
Q

Cognitive problems after stroke

A

Dyspraxia
Impaired attention and concentration
Impaired executive function
Spatial awarenedd eg left sided neglect, hemianopia

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10
Q

Visual problems after stroke

A

Altered acuity, hemianopia, diplopia, nysstagmus, blurred

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10
Q

Visual problems after stroke

A

Altered acuity, hemianopia, diplopia, nysstagmus, blurred

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11
Q

Communication problems after

A
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12
Q

Causes of TIA

A

Thrombus formation eg AF
Atherosclerosis
Shock
Vasculitis

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13
Q

PresenationTIA

A

Sudden weakness of limbs
Sudden facial weakness
Sudden onset dysphasia (speech disturbance)
Sudden onset visual or sensory loss

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14
Q

FAST tool

A

Face
Arm
Speec
Time - act fast 999

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15
Q

ROSIER tool when is stroke likely

A

If score above 0

16
Q

Secondary prevention of stroke medication(long term managemtent)

A

Clopidogrel 75mg oncec daily
Atorvastatin 70mg
Carotid endarectomy or stent if CAD
Treat modifiable risk factors

17
Q

Causes of TIA

A

embolic, thrombotic, haemorrhagic
Carotid bifurcation

18
Q

Long term prevention of TIA

A

HPTN, DM, obesity, smoking - decerase risk factors/treat

19
Q

Investigations TIA

A

BLoods
ECG/ambulatory ECG
CT brain
MRI brain
Carotid imaging eg doppler and duplex, CTPA
Transoesophageal ECHO

20
Q

What bloods do in TIA

A

FBC, ESR/CRP, U+Es, LFTs, TFTs, glucose cholesterol, clotting factors and antiphospholipid antibodies

21
Q

What are CT brain and MRI used for?m

A

Rule out haemorrhage
MRI - region of ischaemia

22
Q

Why do carotid imaging in TIA

A

Check for atheroma and stenosis

23
Q

ECHO in TIA for what

A

Rule out transmural thrombus, valvular HD

24
Q

How long cant drive after a TIA vs multiple

A

1 month
Multiple over short period - 3 months + notify DVLA

25
Q

What are the features of carotid territory symptoms?

A

Amourosis fugax
Aphasia
Hemiparesis
Hemisensory loss
Hemianopic visual loss

26
Q

Features of vertobrobasilar territory symptoms

A

Diplopi a
Vertigo
Vommitting
Choking and dysarthria
Ataxia
Hemisensory loss
Hemianopic or bilateral visual loss
Tetraparesis
LOC

26
Q

Features of vertobrobasilar territory symptoms

A

Diplopi a
Vertigo
Vommitting
Choking and dysarthria
Ataxia
Hemisensory loss
Hemianopic or bilateral visual loss
Tetraparesis
LOC

27
Q

Differentials for TIA

A

Stroke
Hypoglycaemia
Migraine with aura
Focal epilepsy
Intracranial lesion eg tumour or haemorrhage
Hyperventialtion
Retinal or vitreous haemorrhage
Labyrinth disorder
Maliganant HPTN

28
Q

Score for deciding TIA managment

A

ABCD2 score

29
Q

ABCD2 score

A

Age over 60
BP over 140/90
Clinical featires - unilateral weakness, speech disturbance
Duration symptoms - over 60 mins = 2, 10-59 imns = 1
Diabetes w

30
Q

What is low risk and high risk on ABCD2

A

1-3 = low
6-7 = high

31
Q

Absolute contraindications for thrombolysis in stroke

A

Prev intracrnaial haemorrhage
Seizure at onset of stroke
Intracranial neoplasm
Sus SAH
Stroke/traumatic head injury prev 3 months
LP in last week
GI haemorrhage last 3 weeks
Active bleed
Pregnancy
Oesophageal varices
Uncontrolled HPTN >200/120

32
Q

Relative contraindications for thrombolysis stoke

A

Concurrent anticoagulation - INR >1.7
Haemorrhegic diathesis
Active diabetic haemorrhagic retinopathy
Sus intracardiac thrommbus
Major surgery or trauma in last 2 weeks

32
Q

Relative contraindications for thrombolysis stoke

A

Concurrent anticoagulation - INR >1.7
Haemorrhegic diathesis
Active diabetic haemorrhagic retinopathy
Sus intracardiac thrommbus
Major surgery or trauma in last 2 weeks

ENT, neuro, eyes (34 decks)

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