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Flashcards in Stroke & TIA Deck (16):
1

How is a stroke clinically diagnosed?

-Sudden onset
-Focal neuro deficit
-Of presumed vascular origin
-Symptoms lasting 24hrs+ or death
-TIA= symptoms less than 24hrs

2

What are the 2 types of stroke

-Cerebral Haemorrhagic
-Cerebral Infarction/ischaemia

3

What is the pathophysiology of acute ischaemic stroke?

-Initial reduction in cerebral blood flow
-Cellular necrosis
-Alterations in cellular chemistry caused by ischaemia

4

Describe cerebral metabolism

-Glucose is the sole substrate for energy metabolism
-Glucose is metabolised by glycolytic sequence & tricarboxylic acid cycle
-Neurons require constant supply of ATP to maintain integrity-cannot be stored

5

What are causes of ischaemic stroke?

-Thrombosis= large (extra-cranial) & small (intra-cranial) arteries
-Embolism= from heart (cariogenic-AF) & proximal arteries (artery to artery)

6

Which artery occlusion has the highest mortality/disability rate?

Proximal anterior circulation in ischaemic stroke

7

How do stents work?

1) Place stent across occlusion-leave for 10mins
2) Reperfuse brain
3) Most cot will lyse neutrally/impove efficacy
4) Withdraw stent with small clot core

8

What are the causes of a TIA?

-Carotid artery disease/large artery disease
-Cerebral small vessel disease
-Cardiac embolism

9

What can a TIA mimic?

-Seizures
-Syncope
-Hypoglycaemia
-Migraine
-Acute confusional states

10

What are signs of an anterior circulatory TIA?

-Amarausis fugax
-Dysphasia
-Apraxia
-Inattention

11

What are signs of a posterior circulatory TIA?

-Ataxia
-Diploplia
-Vertigo
-Bilateral symptoms

12

What are signs of either an anterior or posterior circulatory TIA?

-Visual field defects (hemianopia)
-Hemiparesis
-Dysarthria
-Hemisensory loss

13

How can risk be assessed for stroke/TIA?

-ABCD2 score
-A= Age (above 60=1)
-B=BP (above 140/90=1)
-C=Clinical features (unilateral weakness=2, speech=1)
-D=Diabetes (yes=1)
-D=Duration of symptoms (60+mins=2, -10mins=0)

14

What is in a polypill?

-Statin
-Aspirin
-Folic acid
-Antihypertensives

15

What type of surgery is used for secondary vascular prevention?

Carotid endarterectomy

16

What is the management of occluded carotid artery?

-No intervention
-Lower risk of further events if good collaterals
-Technically impossible