Stroke and TIA

Question 1

What is the definition of a stroke and TIA?

Answer 1

TIA: an acute onset, focal neurological deficit with vascular origin less than 24 hours (though most last less than an hour)
Stoke: an acute onset, focal neurological deficit with vascular origin longer than 24 hours

Question 2

How common are stokes?

Answer 2

Approximately 152000 strokes a year in the UK

Question 3

Explain the pathophysiology of a stroke/TIA?

Answer 3

Most strokes are ischemic
• Occur due to arterial embolism/thrombus
• Occurs in the carotid, vertebral or cerebral arteries
• TIA’s normally due to microemboli = temporary drop in perfusion
• Around 15% are haemorrhagic
• Lacunar – arms, face and legs are affected, higher cortical function preserved
• Partial anterior circulation infarct (TACI) – 2/3 of arm, face and legs affected and higher cortical defects
• Total anterior circulation stroke (PACS) – 2/3 of arm, face and legs affected and higher cortical defects and visual neglect
• Posterior circulation stroke (PCS) – cerebellar and brainstem signs e.g. lateral medullary syndrome

Question 4

What are the risk factors/aetiology?

Answer 4

• Black origin
• Smoking
• Diabetes
• Obesity
• OCP
• ↑ alcohol
• Bleeding disorders = haemorrhagic stroke
• Anticoagulants = haemorrhagic stroke
• Hypertension = haemorrhagic stroke
• Cancer = haemorrhagic stroke
• Amyloid disease = haemorrhagic stroke
• AV malformations = haemorrhagic stroke
• AF = ischemic stroke
• Atherosclerosis in carotid arteries = ischemic stroke
• Vasculitis = ischemic stroke
• Patent foramen ovale = ischemic stroke

Question 5

What are the signs/symptoms of strokes and TIA’s?

Answer 5

• Face
• Arms
• Speech
• Time
• Amaurosis fugax (shutter blindness of the eyes due to retinal artery occlusion) – TIA
• Hemisensory loss
• Hemianopic visual loss
• Chocking/dysarthria
• Diplopia
• Vertigo
• Vomiting
• Loss of consciousness – rare
• Carotid bruits
• Hemiparesis on the contralateral side
• Spasticity +/- clonus – UMN lesion
• Weakness in extensors of arms and flexors of legs – UMN lesion
• ↑ tendon reflexes – UMN lesion
• Pronator drift – UMN lesion

Question 6

What investigations are carried out for a suspected stroke?

Answer 6

• FBC
• U&E
• Cholesterol
• Plasma viscosity
• Clotting/INR
• HbA1c
• ERS
• Creatinine
• CT – sometimes ischemic stroke doesn’t show for hours
• MRI – stroke shows within 15 mins
• Carotid Doppler
• Echo – check for patent foramen ovale, valve disease, enlarged artia, endocarditis
• ECG
• ABCD2 risk score – risk of stroke after a TIA

Question 7

How will having a stroke/TIA affect a patients ability to drive?

Answer 7

Patients should not drive for a month after a TIA or stroke – maybe longer if there are complications/brain surgery involved

Question 8

What are the surgical treatments for a stroke?

Answer 8

• Carotid endarterectomy – for patients with carotid artery stenosis

Question 9

What are the pharmacological treatments for a stroke?

Answer 9

• Thrombolysis – ischemic stroke only, must be given within 4.5 hours of the stroke
• Aspirin – ischemic
• Anticoagulant
• Antihypertensives
• Statin

Question 10

What are the non pharmacological treatments for a stroke?

Answer 10

• ABCD2 risk score – risk of stroke after a TIA
• Speech and language therapy
• Physiotherapy
• Occupational therapy