Stroke

Question 1

TIA Definition

Answer 1

Clinical picture similar to a stroke, transient and reversible, deficit lasting longer than 24hours is a stroke, most TIAs last 10-15 minutes

Question 2

Stroke/TIA Epidemiology

Answer 2

Affects elderly, black men more

Question 3

Stroke/TIA Aetiology

Answer 3

Usually embolic, can be thrombotic, occasionally haemorrhagic

• Most common source is carotid bifurcation
• Can be from AF, vertebrobasilar arteries

Question 4

Receptive vs Expressive Aphasia?

Answer 4

Wernicke’s (receptive)
-Cannot understand words, fluent aphasia, can make sentences well but the content does not make sense
Broca’s (expressive)
-Can’t form words but can understand, struggle to make words

Question 5

Stroke/TIA Presentation

Answer 5

Sudden weakness, facial (2/3), arms, speech, amaurosis fugax

Question 6

TIA Management

Answer 6

• Only if symptoms resolved give 300mg aspirin daily until TIA appointment, after 2weeks switch to clopidogrel
• Control hypertension, hyperlipidaemia (cautiously)
• Anticoagulation if cardiac source
• Carotid endarterectomy

Question 7

Stroke/TIA Differentials

Answer 7

Migraine, focal epileptic seizure, Todd’s paralysis and paresis, intracranial lesion, syncope, metabolic, MS, beauty parlour syndrome, subdural haemorrhage

Question 8

Stroke/TIA ABCD2 score?

Answer 8

Age, blood pressure, clinical features, duration of symptoms, diabetes
-If score is four or more, anti platelet therapy and urgent referral, if less just referral

Question 9

Stroke Types

Answer 9

Total anterior stroke (TACS)
-Unilateral weakness
-Hemianopia and
-Higher dysfunction (dysphasia, visuospatial disorder)
Partial anterior stroke (PACS)
-2 of 3 TACS features
Lacunar syndrome (LACS)
-Pure motor or sensory loss or both or contralateral ataxic hemiparesis
Posterior circulation syndrome (POCS)
-Cranial nerve palsy and contralateral weakness
-Bilateral motor/sensory deficit
-Conjugate eye movement disorders
-Cerebellar dysfunction
-Isolated homonymous hemianopia
-Alexia without agraphia

Question 10

Stroke Acute Management

Answer 10

Stroke
-Maintain homeostasis (glucose, oxygen)
-Screen swallow
-CT within 1 hour
-If haemorrhagic excluded; 300mg aspirin for 2 weeks then long term
-Thrombolysis with alteplase by trained team if onset ≤4.5 hours
-Thrombectomy
TIA
-Modify lifestyle
-Clopidogrel loading dose 300mg followed by 75mg daily
-High intensity statin therapy with atorvastatin 20-80mg a day
-Lower BP (cautiously) with thiazide like diuretic

Question 11

Stroke Thrombolysis Contraindications

Answer 11

-Seizure at onset of stroke
-Symptoms suggestive of subarachnoid haemorrhage
-Stroke or serious head injury in the preceding three months
-Major surgery or serious trauma within three months
-Previous intracranial haemorrhage
-Intracranial neoplasm or surgery
-Arteriovenous malformation or aneurysm
-Gastrointestinal or urinary tract haemorrhage in the preceding three weeks
-Lumbar puncture in the preceding week
-Current anticoagulation (INR >1.7).
-Acute pericarditis
-Significant bleeding, bleeding disorder or anticoagulant treatment
-Severe uncontrolled arterial hypertension
-Severe liver disease.
Bacterial endocarditis, pericarditis, acute pancreatitis
-Prior stroke within three months, or any stroke with concomitant diabetes

Question 12

Stroke Diagnosis

Answer 12

ROSIER (any validated tool), always check blood sugar