Stroke + TIA

Question 1

define TIA

Answer 1

less than 24hr transient focal neurology with tissue ischaemia

Question 2

what is TIA a marker of

Answer 2

markrer of IHD
often precedes stroke

Question 3

gold standard diagnostic test for TIA

Answer 3

MRI

Question 4

driving rules after TIA

Answer 4

cant drive for 1 month after TIA

Question 5

Define stroke

Answer 5

more than 24hr focal neurologic deficit with tissue infarction

Question 6

2 causes of stroke

Answer 6

ischaemic - 85%
haemhhoragic - 15%

Question 7

mc cause of ischaemic stroke

Answer 7

carotid thromboembolus

Question 8

other causes of ischaemic stroke

Answer 8

atherogenesis
ASD
AF
IE

Question 9

examples of haemhhoragic stroke

Answer 9

EDH
SOH
SAH
ICH
trauma
alcoholism
anticoags
berry aneurysm

Question 10

RF for stroke

Answer 10

CV risk factors
AF

for haemhorragic:
anticoagulation use
AD PKD

Question 11

how to classify types of stroke

Answer 11

Bamford/Oxford classification

Question 12

describe TACS

Answer 12

total anterior circulation stroke
affects anterior + middle cerebral artery
3/3sx:
1. higher cortical dysfunction
2. homonymous haemanopia
3. U/L hemiplegia of hemi sensory loss

Question 13

describe PACS

Answer 13

Partial Anterior Circulation Stroke (
only affects anterior OR only middle cerebral artery
2/3 sx

Question 14

Describe POCS

Answer 14

Posterior Circulation Stroke
affects brainstem, cerebellum, thalamus, occipito parietal lobes
sx:
1 of:
- isolated vision loss
- cerebellar sx
- contralateral cranial nerve palsy

Question 15

describe lacunar stroke

Answer 15

affects small, deep bloodvessels
can get pure motor, pure sensory or ataxic hemiparesis

Question 16

what locations can stroke occur

Answer 16

1. anterior cerebral artery
2. middle cerebral artery
3. posterior cerebral artery
4. midbrain
5. lateral medulla
6. basilar artery
7. retinal artery

Question 17

describe anterior cerebral artery stroke sx

Answer 17

contrakateral weakness + sensory deficit more in lower limb
urinary/faecal incontinence
impaired judgement
+/- personality changes

Question 18

describe middle cerebral artery stroke sx

Answer 18

affects upper limb more
ipsilateral gaze deviation
face drop contralateral (forehead spared)
broca/wernickes of domninant hemisphere

Question 19

describe posterior cerebral artery stroke sx

Answer 19

isolated vision changes
eg painful cn3 palsy, homonymous hemi + macular sparing

Question 20

describe midbrain stroke sx

Answer 20

aka webers
ispilateral CN3 palsy and contralateral hemiplegia

Question 21

describe lateral medulla stroke sx

Answer 21

aka wallenburg
ispilateral spinothaolamic face loss
contralateral spinothalamic rest of body loss
dysphagia
ispilateral horners
ispilateral DANISH

Question 22

describe sx of basilar artery stroke

Answer 22

locked in syndrome

Question 23

describe sx of retinal artery stroke

Answer 23

amaurosis fugax

Question 24

investigations for stroke

Answer 24

1. rule out stroke mimics + hypoglycaemia –> bloods
2. imaging
3. doppler ultrasound of carotids

Question 25

first line imaging for stroke

Answer 25

NCCT head - will rule out haemhhoragic

Question 26

gold standard imaging for stroke

Answer 26

diffusion weighted MRI

Question 27

TX of ischaemic stroke if less than 4.5hr from sx onset

Answer 27

IV altepase/tenecteplase (thrombolysis) consider thrombectomy if clot in large artery and within 6hr

Question 28

when is thrombolysis CI

Answer 28

bleed disorders HTN IE

Question 29

SE of thromboylsis

Answer 29

bleeding

Question 30

TX of ischaemic stroke if more than 4.5hr from sx onset

Answer 30

300mg loading dose STAT aspirin

Question 31

long term prevention of stroke

Answer 31

HALTS Hypertension manegement Anticoagulation management Lipid lowering Tobaco stop sugar/surgery (manage diabetes)

Question 32

how to manage hypertension when preventing stroke

Answer 32

high dose statin

Question 33

how to manage anticoagulaition when preventing stroke

Answer 33

2 weeks aspirin loading dose lifeong clopidogrel 75mg

Question 34

when to consider surgery for stroke prevention

Answer 34

consider carotid endartectomy when more than 70%

Question 35

what scores are used for stroke

Answer 35

FAST ROSIER

Question 36

when is FAST used

Answer 36

in community face arms speech time

Question 37

when is ROSIER used

Answer 37

in hospital more than 0 = chance of stroke do blood glucose to rule out hypogylcaemia first