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Stroke and TIA (TIA (ABCD2 Score
A = Age >60
B = BP Systolic > 140…
Stroke and TIA
TIA
Symptoms
- Maximal at onset
- <24hrs (usually 10-15mins)
- Amaurosis fugax / visual loss, diplopia
- Unilateral weakness or sensory deficit
- Dysarthria / dysphasia / dysphagia
- Vertigo
A sudden onset of focal neurological deficit, maximal at onset, with complete resolution of symptoms within 24 hours
ABCD2 Score
A = Age >60
B = BP Systolic > 140 or Diastolic > 90
C = Clinical features - unilateral weakness (2), dysphasia (1)
D = Duration of symptoms - >60mins (2), 10-59mins (1)
D = Diabetes
Patients considered high risk - need urgent assessment / Score 4+ on ABCD2 score
- Aspirin 300mg with PPI as soon as possible
- Clopidogrel 75mg daily for secondary prevention
Management
- ABCDE
- ABCD2 Score
- If >4 - 300mg Aspirin +PPI
- Bloods: FBC, U&E, glucose, lipids, ESR, LFTs
- Inform not to drive for 4 weeks
- Safety net - come back to A&E if any further events
- Secondary prevention if score >4 - Clopidogrel 75mg OD
- Refer to TIA clinic
- If residual or ongoing neurology - assume a stroke and admit
Secondary prevention
- Smoking cessation
- Diet - reduced salt, low fat
- Regular exercise
- Reduce alcohol
- Body weight management
- Statin
Other patients at high risk of subsequent stroke regardless of ABCD2 Score:
- AF
- Anticoagulated (require brain imaging)
- More than one TIA in last 7 days
- If high risk - neurovascular assessment within 24hrs
- If low risk - neurovascular assessment within 7 days
Stroke
Risk Factors
- AF (5x)
- Age
- Diabetes
- HTN
- Smoking
- CCF, IHD, cardiac disease
- Alcohol
- Obesity
- OCP, HRT, pregnancy
- Sickle cell, haemophilia, SLE, PVD
- FHx
- IVDU
- Long bone fracture
- Previous TIA
Causes
- 85% strokes are ischaemic - THROMBOSIS / EMBOLI
- Hypotension > watershed strokes
Symptoms
- Same as TIA but for longer, hemianopia, LOC
- FAST
Stroke mimics
- Hypoglycaemia
- Migraine
- Intoxication
- Todd's palsy
- Mass lesion
- SAH
- Syncope
Management
- ABCDE
- Exclude hypoglycaemia
- FAST screen
- Establish diagnosis - ROSIER
- Assess for scanning and if indicated scan immediately
- Thrombolyse if indicated (<4.5hrs from symptom onset)
- Admit to an acute stroke unit
- Screen for malnutrition and perform swallowing assessment
- Early mobilisation and positioning following assessment
ISCHAEMIC
- Aspirin 300mg unless CI
- Control hydration, temp, BP, maintain O2, blood sugar
- ? Surgical intervention - refer within 24 hours onset if indicated
HAEMORRHAGIC
- Reverse anticoagulation if indicated
- Control hydration, temp, BP, maintain O2, blood sugar
- Surgical referral if previously fit and haemorrhage with hydrocephalus or deteriorating neurologically
- Medical treatment if surgery not appropriate
Medical treatment prior to discharge
- Cholesterol lowering
- BP control
- Dietary advice
- Antiplatelet treatment
- Lifestyle advice
ROSIER Scale
- LOC (-1)
- Seizure activity (-1)
NEW ACUTE ONSET OF
- Asymmetric facial weakness (+1)
- Asymmetric arm weakness (+1)
- Asymmetric leg weakness (+1)
- Speech disturbance (+1)
- Visual field defect (+1)
-2-+5
Stroke is likely if score >0
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