Stroke and TIA

• Give the two types of stroke

  Ischaemic - Ischaemia or infarction of the brain tissue seondary to a disrupted blood supply

  Haemorrhagic - intracranial haemorrhage with bleeding in or around the brain
• What is ischaemia?

  Inadequate blood supply
• What is infarction?

  Tissue death due to lack of blood supply.
• What comes first, ischaemia or infarction?

  Ischaemia
• Give four causes of disruption of the blood supply to the brain?

  Thrombus or embolus

  Atherosclerosis

  Shock

  Vasculitis
• What is TIA?

  Transient ischaemic attack involves temporary neurological dusfunction (lasting less than 24 hours) caused by ischaemia but without infarction. Symptoms have a rapid onset and often resolve before the patient is seen.
• Can TIAs precede a stroke?

  Yes
• What is crescendo TIA?

  Two or more TIAs within a week and indicate a high risk of stroke.
• Give symptoms of stroke

  Asymmetrical...

  Limb weakness

  Facial weakness

  Dysphasia

  Visual field defects

  Sensory loss

  Ataxia and vertigo
• A blockage in which artery would cause ataxia and vertigo?

  Posterior cerebral artery
• Give 12 risk factors for stroke/TIA

  Previous stroke or TIA

  Atrial fibrillation

  Carotid artery stenosis

  Hypertension

  Diabetes

  Raised cholesterol

  Family history

  Smoking

  Obesity

  Vasculitis

  Thrombophilia

  Combines contraceptive pill
• What increases the risk of stroke when using the oral contraceptive pill?

  Migraines with aura

  Smokers over 34 years

  History of stroke or TIA
• Which two tools are used to recognise stroke?

  FAST

  Rosier
• How do you manage TIA?

  Aspirin 300mg daily

  Referral for specialist assessment within 24 hours

  Diffusion-weighted MRI scan
• How do you manage stroke?

  Exclude hypoglycaemia

  CT brain to exclude haemorrhage

  Aspirin 300mg daily for 2 weeks (after excluding haemorrhage on CT)

  Admission to a specialist stroke centre

  Thrombolysis with alteplase within 4.5 hours of symptom onset

  OR thrombectomy in patients with a confirmed blockage of proximal anterior circulation or proximal posterior circulation - it may be considered within 24 hours.
• In patients with an ischaemic stroke, is it a good or bad idea to lower the blood pressure?

  Lowering the blood pressure can worsen the ischaemia.
• Patients with TIA or stroke should be investigated for what conditions?

  Carotid artery stenosis

  Atrial fibrillation
• What is given for secondary prevention of stroke?

  Clopidogrel 75mg once daily

  Atorvastatin 20-80mg
• What else is important in secondary prevention of stroke other than medications?

  Blood pressure and diabetes control

  Addressing modifiable risk factors (smoking, obesity, exercise)