Stroke & TIA

Question 1

How is a stroke clinically diagnosed?

Answer 1

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

Question 2

What are the 2 types of stroke

Answer 2

• Cerebral Haemorrhagic

- Cerebral Infarction/ischaemia

Question 3

What is the pathophysiology of acute ischaemic stroke?

Answer 3

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

Question 4

Describe cerebral metabolism

Answer 4

• 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

Question 5

What are causes of ischaemic stroke?

Answer 5

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

Question 6

Which artery occlusion has the highest mortality/disability rate?

Answer 6

Proximal anterior circulation in ischaemic stroke

Question 7

How do stents work?

Answer 7

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

Question 8

What are the causes of a TIA?

Answer 8

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

Question 9

What can a TIA mimic?

Answer 9

• Seizures
• Syncope
• Hypoglycaemia
• Migraine
• Acute confusional states

Question 10

What are signs of an anterior circulatory TIA?

Answer 10

• Amarausis fugax
• Dysphasia
• Apraxia
• Inattention

Question 11

What are signs of a posterior circulatory TIA?

Answer 11

• Ataxia
• Diploplia
• Vertigo
• Bilateral symptoms

Question 12

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

Answer 12

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

Question 13

How can risk be assessed for stroke/TIA?

Answer 13

• 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)

Question 14

What is in a polypill?

Answer 14

• Statin
• Aspirin
• Folic acid
• Antihypertensives

Question 15

What type of surgery is used for secondary vascular prevention?

Answer 15

Carotid endarterectomy

Question 16

What is the management of occluded carotid artery?

Answer 16

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