Stroke + TIA

Question 1

How common is it

Answer 1

3rd most common cause of death

Question 2

What are the risk factors

Answer 2

• HTN
• DM
• AF
• Hyperlipidaemia
• Structural cardiac disease
• Lifestyle
• ABCD2 score of >4

Question 3

What are the symptoms

Answer 3

• Disorder of balance, co-ordination, preception
• Unilateral weakness
• Visual field defect

Question 4

What are the signs / can you tell difference

Answer 4

• SUDDEN ONSET - progressing symptoms
• ISCHAEMIC = carotid bruits, AF, past TIA, IHD
• HAEMORRHAGE = meningism, sev headache, coma

Question 5

How does a cerebral infarct present + what % of infarcts is it

Answer 5

50% of strokes

• Contralateral hemiplegia
• Initially FLACCID LIMBS –> SPASTIC (UMN) –> contralateral sensory loss + dysphagia + visuo-spatial defect + homonymous hemianopia

Question 6

How does a brainstem infarct present + what % of infarcts is it

Answer 6

25%

• locked in syndrome
• quadriplegia
• disturbance to gaze/vision

Question 7

How does a lacunar infarct present + what % of infarcts is it

Answer 7

25%
Around basal ganglia, internal capsule, thalamus, pons 
- Cognition intact
- Purely motor atxic hemiparesis 
- Pure sensory 
- mixed sensorimotor + dysarthria

Question 8

How do you investigated stroke + TIA

Answer 8

• CT head
• ABCD2
  Age >60yrs = 1 point
  BP >140/90mmHg = 1 point
  Clinical feat - unilat weakness= 2 point, speech disturbances w.out weakness = 1 points
  Duration symptoms >60mins = 2 points
  Diabetes = 1 point

Question 9

How do you manage stroke post-operatively

Answer 9

DO NOT START ANTI-PLATELET MED until confirmed w/ CT non-haemorrhagic

• Simvastatin
• Antiplatelet e.g. clopidogrel, aspirin

Question 10

How do you manage neuropathic pain

Answer 10

Amitriptyline, gabapentin, carbamazepine