stroke and TI

What is a stroke? 4

• Clinical syndrome of presumed vascular origin

• Rapid onset

• Focal or global neurological deficit

• Symptoms last >24 hours OR lead to death

What is a Transient Ischaemic Attack (TIA)? 3

• Transient (<24 hours) episode of focal neurological dysfunction

• Caused by focal brain, spinal cord, or retinal ischaemia

• No evidence of acute infarction on imaging

What complications can occur after a stroke and how should treatment be approached?

Stroke
⬇
Complications
⬇
• Neurological problems
• Depression & anxiety
• Communication difficulties
• Difficulty with activities of daily living
⬇
Management Approach
⬇
• Treat physical symptoms
• Treat psychological symptoms

What acronym can be used to remember common sudden symptoms of Stroke/TIA? WNSV

• W – Weakness

• N – Numbness

• S – Slurred speech

• V – Visual disturbance

When should TIA vs stroke be suspected?

• TIA: Resolved within 24 hours

• Stroke: Persists >24 hours or ongoing

What does management of stroke/TIA depend on?

1. Diagnosis (including timing of incident)

2. Type of stroke

What is a TIA and what are its main mechanisms? 3

• “Mini stroke”

• Symptoms resolve within 24 hours

• 3 mechanisms:

  • Large artery low-flow

  • Embolic

  • Lacunar (small vessel)

What characterises a Large Artery Low-Flow (True) TIA? 4

• Obstructive process in extra- or intra-cranial arteries

• Short-lived (minutes)

• Often recurrent (may occur several times/year)

• Ischaemic symptoms:

  • Numbness (hand, arm, leg, face, tongue, cheek)

What characterises an Embolic TIA? 5

• Caused by an embolus

• Usually from extra-cranial artery

• Common causes: AF, LV thrombus

• Lasts hours (not minutes)

• Often infrequent

What characterises a Lacunar (small vessel) TIA?

• Stenosis of small penetrating intracerebral vessels

• Causes transient cerebral ischaemia

When should you suspect a TIA? (Acronym: SUD-24)**

• S – Sudden onset

• U – Unexplained by another condition (e.g. hypoglycaemia)

• D – Deficit is focal neurological

• 24 – Completely resolved within 24 hours

What focal neurological deficits occur in TIA? (Acronym: VISION-DAS)**

• V – Vision loss

• I – Imbalance , vertigo,

• S – Sensory loss

• I – Impaired speech

• O – One-sided weakness

• N – Nerve (cranial nerve defects)

• DAS – Dizziness, Syncope

When should you suspect a Stroke? (Acronym: SUD-24+)

SUD-24+

• S – Sudden onset

• U – Unexplained by another condition (e.g. hypoglycaemia)

• D – Deficit is focal neurological

• 24+ – Ongoing or persists >24 hours

: What clinical features suggest Stroke rather than TIA? (Acronym: CHIC)**

• C – Confusion, reduced consciousness, coma

• H – Headache

  • Gradual → intracranial haemorrhage

  • Sudden severe → subarachnoid haemorrhage (± neck stiffness, sentinel headache)

• I – Increased intracranial pressure signs (nausea/vomiting)

• C – Continuous deficit (>24 hours)

what are the two types of stroke?

• ischaemic

• haemorrhagic

What are the key features of an Ischaemic Stroke?

• Caused by arterial occlusion (thrombus or embolus)=narrowing of the blood vessels

• • Thrombotic → complication of atherosclerosis

  • Embolic → clot from herosclerotic plaque or a clot in a larger artery of the heart

  • 85% strokes

What are the key features of a Haemorrhagic Stroke?

Caused by bleeding into brain

How can you remember the main risk factors for stroke? (Mnemonic: “SAD AF HIP SHID”)

• S – Smoking

• A – Alcohol/drug misuse

• D – Diabetes

• A – Age ↑

• F – Fat (Hyperlipidaemia)

• H – Hypertension

• I – IHD (Ischaemic Heart Disease)

• P – Physical inactivity

• S – Stroke/TIA previous

• H – Heart failure

• I – Ischaemic events (MI)

• D – Diet poor

Key early complications after stroke early period? 4

• Cerebral oedema – Brain swelling

• Delirium – Sudden confusion/altered consciousness

• Seizures

• Blood clots in veins

Key long-term complications after stroke/TIA (with examples) 5

• Mobility problems – e.g., , difficulty walking

• Cognitive problems – e.g., memory loss, impaired attention

• Emotional/psychological problems – e.g., depression, anxiety

• Difficulties with activities of daily living (ADLs) – e.g., trouble dressing

• communication problems

l01)Define and describe the differences between Stroke and TIA

• Duration: Stroke >24h; TIA <24h (usually <1h)

• Brain damage: Stroke permanent; TIA none

• Imaging: Stroke shows infarct/bleed; TIA normal

• Risk: Stroke needs acute care; TIA = warning for future stroke

• Clinical features: Both sudden focal deficits; TIA fully resolve