TIA and Stroke Flashcards
Crescendo TIA =
2< episodes within one week
4 causes of TIA
Embolus from carotid artery
Thrombus rom the heart due to AF
Infective endocarditis
Vasculitis
How long can’t you drive for with a TIA
4 weeks
If the patient has had more than 1 TIA (‘crescendo TIA’) or has a suspected cardioembolic source or severe carotid stenosis:
Management..?
300mg Aspirin immediately
discuss the need for admission or observation urgently with a stroke specialist
cannot drive until they see a specialist
If the patient has had a suspected TIA in the last 7 days:
Management..?
300mg Aspirin immediately
arrange urgent assessment (within 24 hours) by a specialist stroke physician
cannot drive until they see a specialist
Carotid stenosis 50-99% treatment
referred within 1 weeks for carotid endarterectomy
undergo treatments within 2 weeks
Carotid stenosis <50% treatment
no surgery just medical management
6 vascular risk factors for TIA
HTN IHD PVD Carotid stenosis Diabetes Smoking
4 thrombotic risk factors for TIA
AF
COC
Polycthaemia
Clotting disorders
TACS classification (3)
All 3 of ….
- unilateral weakness
- homonymous hemianopia
- higher cerebral dysfunction
PACS classification (3)
2 of…
- unilateral weakness
- homonymous hemianopia
- higher cerebral dysfunction
PCS classification (3)
1 of….
- cerebellar / brainstem syndromes
- loss of consciousness
- isolated homonymous hemianopia
LACS classification (3)
1 of….
- unilateral weakness (purely)
- pure sensory stroke
- ataxia hemiparesis
Definition of stroke
syndrome of rapid onset of cerebral deficit, usually focal lasting more than 24hrs
5 causes of ischaemic stroke
Thrombosis Large artery stenosis Small vessel disease Cardioembolic Hypoperfusion
2 causes of haemorrhagic stroke
Intracerebral
subarachnoid
3 “other” causes of stroke
arterial dissection
venous sinus thrombosis
vasculitis
Clinical deficit associated with left middle cerebral artery
Right sided weakness of face & arm > leg and dysphasia
Clinical deficit associated with RMCA
left sided weakness - face & arm > leg, visual / sensory neglect, denial of disability
Lesion to corticospinal tracts in BS leads to ….
hemiparesis / tetraparesis
Lesion to oculomotor tract in BS leads to ….
dipolpia
Lesion to 5th nerve nuclei -
facial numbness
Lesion to 7th nerve nuclei -
facial weakness
Lesion to 9th and 10th nerve nuclei -
dysphagia and dysarthria
Lesion to sympathetic fibres in the BS -
Horners syndrome
Lesion to reticular formation -
coma / altered consciousness
If haemorrhagic stroke excluded what should be given straight away?
300mg aspirin
At what cholestrol level should a statin be started post stroke?
3.5mmol/L
Thrombolysis should be given within …..
4.5 hours after the onset of stroke symptoms
What thrombolysis is currently recommended?
altepase
4 causes of haemorrhagic stroke
HTN
Cerebral amyloid angiopathy
Aneurysms
Cerebral ateriovenousmalformations
What stroke scale is used in assessment?
NIHSS (national institute of health stroke scale)
Broca’s aphasia =
expressive aphasia
Wernicke’s aphasia
receptive aphasia
4 coagulopathies that can cause a stroke
Thromboycythaemia
Polycythaemia
Hyperviscosity states
Thrombophilia
Which infections should be considered in stroke?
Neurosyphilis
HIV
Hepitits
Structures that run through the cavernous sinuses (5)
3rd, 4th, 5th and 6th CN
Carotid artery
Classical presentation of cavernous sinus thrombosis (3)
Proptosis
Chemosis
Painful opthalmoplegia
Vasculitis can cause strokes secondary to either (2)
Infection
CTD
Cerebral venous thrombosis associated with… (5)
pregnancy puerperium oral contraception haematological disease infection CTD
Defining features of cerebral venous thrombosis (4)
headache
altered conscious ness
seizures
papilloedema
What should be considered if stroke symptoms after trivial neck trauma?
Dissection
If the patient has had a suspected TIA which occurred more than a week previously:
refer for specialist assessment as soon as possible within 7 days
cannot drive until they see a specialist
anti-platelet therapy started for those who have had a TIA?
Clopidogrel
Contraindications to thrombolysis:
- Previous intracranial haemorrhage
- Seizure at onset of stroke
- Intracranial neoplasm
- Suspected subarachnoid haemorrhage
- Stroke or traumatic brain injury in preceding 3 months
- Lumbar puncture in preceding 7 days
- Gastrointestinal haemorrhage in preceding 3 weeks
- Active bleeding
- Pregnancy
- Oesophageal varices
- Uncontrolled hypertension >200/120mmHg
