Stroke and TIA

Question 1

What is a stroke?

Answer 1

A stroke is an acute neurological deficit caused by a cerebrovascular abnormality

Question 2

What is a TIA?

Answer 2

TIA is a transient episode of neurological dysfunction caused by a focal brain, spinal cord, or retinal ischaemia, without acute infarction. Patients with TIAs are at high risk of ischaemic stroke.

Question 3

What are risk factors for stroke?

Answer 3

• Older age
  
  • Hypertension
  • Family history
  • Atrial fibrillation

Question 4

What is the classification of stroke?

Answer 4

TACS
PACS
POCS
LACS

Question 5

what investigations in stroke?

Answer 5

CT head no contrast 1st line.

CT angio: if suspected large vessel occlusion, means you can give thrombectomy too.

CT perfusion/DWI: if outwith timeframe.

Bloods to rule out things e.g. glucose, electrolytes, PT and INR

Echo+ECG to see if AF and carotid US to see if stenosis.

Question 6

What is treatment for ischaemic stroke?

Answer 6

Thrombolysis (4.5 hours) with alteplase.

Thrombectomy (6 - 24 hours including wake up): for patients with confirmed proximal anterior circulation stroke on CTA/MRA. Can give with thrombolysis if within 6 hours.

Admission to the stroke unit.

Question 7

What is secondary prevention for ischaemic stroke?

Answer 7

Antiplatelets: clopidogrel
Statin
BP control: thiazide diuretic, Ca blocker, or ACEi
Antiocoagulant if patient has AF

Question 8

How is TIA treated?

Answer 8

Aspirin 300mg (unless bleeding disorder or contraindicated or taking it already)

Carotid endarterectomy: if carotid stenosis >70% or with symptomatic stenosis > 50%

Secondary prevention with clopidogrel

Question 9

What is cause of TIA?

Answer 9

Carotid artery stenosis commonly

Question 10

Complications of thrombolysis?

Answer 10

Haemorrhagic transformation

Question 11

What Sx in stroke?

Answer 11

Weakness
sensory disturbance
dysphasia 
visual changes
balance problems

Question 12

What are Sx of location of TACS?

Answer 12

Hemiparesis/hemisensory loss AND higher cortical dysfunction AND hemianopia

Proximal MCA or ICA

Question 13

What are Sx of location of PACS?

Answer 13

Isolated higher cortical dysfunction OR

2 of Hemiparesis/hemisensory loss, higher cortical dysfunction, hemianopia

MCA branch, smaller arteries of anterior circulation

Question 14

What are Sx of location of POCS?

Answer 14

Isolated hemianopia OR brainstem syndrome

Perforating arteries, PCA, cerebeller

Question 15

What are Sx of location of LACS?

Answer 15

Pure motor OR pure sensory OR sensorimotor OR ataxic hemiparesis OR clumsy hand dysarthria

Perforating artrey, small vessel disease

Question 16

Which arteries cause which Sx?

Answer 16

Anterior cerebral = lower limbs
Middle cerebral = upper limbs and head
Posterior cerebral = eyes

Question 17

What Sx may suggest a haemorrhagic stroke?

Answer 17

Decreased consciousness
headache
N+V
seizure

Question 18

Primary prevention for strokes?

Answer 18

Exercise, manage weight, reduce alcohol and smoking, treat underlying conditions e.g. AF, hypertension, high cholesterol, diabetes

Question 19

What are complications of stroke?

Answer 19

Aspiration pneumonia: due to dysphagia. Patients should have swallowing function assessed. Patients may need enteral feeding.

DVT: lack of mobility following stroke causing venous stasis

Depression

Question 20

What MDT in patients with stroke

Answer 20

PT/OT

SALT