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Medicine Notes Neurology Notes

Stroke And Tia Notes

Updated Stroke And Tia Notes

Neurology Notes

Neurology

Approximately 27 pages

Clinically relevant notes covering a broad spectrum of Neurological conditions. Enough depth for the SAQ papers while still containing clinical information and tips for OSCE examinations. More complex conditions are simplified and every condition links back to the history and examination of the patient along with relevant investigations and management. Ideal for both the written and practical exams.
Each subject is colour coded and contains presenting features, aetiology and management....

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The following is a more accessible plain text extract of the PDF sample above, taken from our Neurology Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Stroke and TIA

Epidemiology

  • A major neurological disease of our time

  • 100,000 new strokes/year in the UK (1 every 5 minutes)

  • Accounts for 11% of deaths in the UK (3rd cause of death)

History

  • Timing

    • Sudden onset

    • Usually reaches maximum deficit within an hour

    • TIA recover quickly (usually within 1hr, up to 24hrs)

  • Symptoms

    • Do they fit with a vascular territory?

      • Face, arms, legs, higher cortical, visual (amaurosis fugax, homonymous hemianopia)

  • Associated features

    • May go against a stroke i.e may suggest patient has a stroke mimic

      • LOC

      • Weight loss ? cancer

      • Headache ?migraine ?IOP ?SAH

      • Vomiting ?migraine ?ICP

      • Falls, trauma ?subdural

  • Vascular risk factors such as

    • Diabetes

    • Previous stroke/TIA

    • MI/CABG

    • Hypertension

    • Smoking

    • AF, valve disease

    • Hypercholesterolaemia

    • +ve family history

    • Alcoholism

    • Clotting/bleeding disorders (antiphospholipid syndrome)

  • Drug history

  • PMH

Examination

  • ABCDE

  • General exam

    • Clubbing (? Brain mets)

    • Splinter haemorrhages (?infective endocarditis)

    • Tar staining

    • Pyrexia (? Brain abscess)

  • Look for signs of

    • Hyperlipidaemia (corneal arcus, xanthalasma)

    • Peripheral vascular disease

    • Diabetes

    • Hypertension (LVH, proteinuria)

    • AF

    • DVT

    • Pregnancy/post partum

    • CT diseases (? Antiphospholipid syndrome)

  • CVS exam (looking for signs of cardiac disease that could cause a cardioembolic stroke

  • Neuro exam

    • Does neurology fit in a vascular territory?

    • If TIA, both symptoms and signs must resolve in 24 hours

Aetiology

  • Ischaemic

    • Thrombus (in situ i.e atherosclerosis)

    • Cardioembolic (AF, MI – ventricular wall thrombus)

    • Thromboembolic (cartoids)

  • Haemorrhagic

    • Raised BP

    • Anticoagulants

    • AVM

    • Tumour

Classification

  • OCSP (Oxford Community Stroke Project)

TACS = total anterior circulation syndrome

  • Higher cortical dysfunction e.g dyspraxia, dysphasia, inattention

  • Hemimotor/sensory loss

  • Hemianopia

Often cardioembolic (e.g from AF) – Big emboli – blocks internal carotid. 60% dead at 12 months

PACS = partial anterior circulation syndrome

  • Any combination of two

  • Or just higher cortical dysfunction

Often embolic – carotid>cardiac

POCS = posterior circulation syndrome

  • Hemianopia

  • Cerebellar dysfunction

  • Eye movement problems (CNIII)

  • Bilateral motor/sensory deficit

  • CN palsy +/- contralateral motor/sensory deficit

LACS = lacunar stroke

  • Pure motor deficit

  • Pure sensory deficit

  • Mixed deficit

Often from thrombus in-situ – smaller arteries

Change ‘S’ to ‘I’ (infact) or ‘H’ (haemorrhage) following CT scan

NIHSS (national institutes of health stroke survey) allows monitoring of progress. Barthel index gives indication of person’s independence wit their ADLs

Investigations

  • Bloods

    • FBC, U+E, LFT, glucose, lipids, platelets, clotting

  • Urine dip (proteinuria)

  • ECG

  • Carotid USS

  • CT

  • Echo? 24 hr tape? Cxr?

Stroke mimics

  • SAH

  • SDH

  • Venous infarcts

  • Primary/secondary malignancy

  • Abscesses

  • Hemiplegic migraine

  • Functional hemiparesis

Acute assessment

TIA

  • Is it a TIA?

    • Lasts mins-hours

    • Can be up to 24 hours

    • If >2hrs are they improving?

  • If definitely a TIA – fax referral to TIA clinic

    • High risk within a day

    • Low risk within a week

  • Start aspirin 300mg and Statin 30mg

  • Tell them not to drive (DVLA – 1month ban)

    • Highest risk of stroke in 2 weeks

Risk of subsequent stroke assessed by ABCD2 score

A = age > 60 +1

B = BP >140/90 +1

C = Clinical features – unilateral weakness +2 speech disturbance alone +1

D1 = Duration >60mins +2 <60mins +1

D2 – Diabetes +1

0-3 points = low risk

4-5 points = moderate risk

6-7 points = high risk

Investigations for TIA

  • CUSS

  • Bloods:...

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