TIA and stroke Flashcards
stroke/TIA mimics
seizures - focal epilepsy sepsis syncope hypoglycaemia - check BM migraine aura
symptoms of a stroke
RAPID ONSET!! seconds - minutes FAST - face, arms, speech sensory loss weakness dysphagia visual field defects ataxic hemiparesis
how to diagnose a stroke
clinical not radiological NIHSS score - NIH stroke scale score before and after thrombolysis 0 = no stroke 1-4 = minor 5-15 = moderate 16-20 = moderate-severe 21-42 = severe
section level of consciousness patient knows month and own age patient opens and closes eyes on command visual field testing best gaze - only horizontal wye movements facial paresis motor function of right arm motor function of left arm motor function of right leg motor function of left leg limb ataxia sensory by pinprick language dysarthia extinction and inattention
causes and types of stroke
isachaemic stroke (85%)
caused by an embolus or a thrombus
artery narrows or becomes blocked
haemorrhage stroke (15%)
risk factors for haemorrhage stroke
HTN
cerebral amyloid angiopathy - weakened blood vessels in the elderly patients
aneurysms
cerebral arteriovenous malformations
Oxford stroke/bamford classification
TACS - total anterior circulation stroke
PACS - partial anterior circulation stroke
POCS - posterior circulation stroke
LACS - lacunar stroke
total anterior circulation stroke
large cortical stroke in middle/anterior cerebral artery areas
all 3 of:
- unilateral weakness and/or sensory deficit of face, arm and leg
- homonymous hemianopia
- higher cerebral dysfunction (dysphasia, visuospatial disorder)
Partial anterior circulation syndrome
cordial stroke in middle/anterior cerebral artery areas
two of:
- unilateral weakness and/or sensory deficit of face, arm and leg
- homonymous hemianopia
- higher cerebral dysfunction (dysphasia, visuospatial disorder)
posterior circulation syndrome
one of:
- cerebellar or brainstem syndromes
- LOC
- isolated homonymous hemianopia
Lacunar stroke
subcortical stroke due to small vessel disease, no evidence higher cerebral dysfunction and one of:
- unilateral weakness and/or sensory deficit of face, arm and leg
- pure sensory stroke
- ataxic hemiparesis
differential diagnosis of stroke
head injury hypo/hyperglycaemia subdural haemorrhage intracranial tumour hemiplegic migraine epilepsy (Todds palsy) drug OD
acute management of stroke
ABCDE
protect airway - hypoxia/aspiration
pulse, BP, ECG - embolus from AF?
blood glucose - IV dextrose if low
urgent CT head
if thrombosis considered, cerebellar stroke, high risk of haemorrhage - decreased GCS, signs on increased ICP, severe headache, meningism, progressive symptoms, known bleeding tendency or anticoagulation
otherwise imaging can wait aim <24h
MRI - best for showing infarcts, CT primary bleeds
if no signs of haemorrhage - thrombolysis if onset of symptoms <4.5 hours ago (TPA - tissue plasminogen activator) Altepase IV
nil by mouth - if swallowing attempts might lead to chocking
once hemorrhagic stroke is excluded give 300mg aspirin
refer to stroke unit
primary prevention of stroke
control and treat RF: HTN DM Hypercholesterolaemia cardiac disease - AF, MI, prosthetic valves help quit smoking exercise
secondary prevention of stroke
control risk factors as in primary
300mg aspirin for 2 weeks then clopidogrel
use warfarin/NOAC if AF
presentation of TIA
sudden onset slurring of speech in clear consciousness unilateral clumisness hand known vascular risk factors complete recovery
