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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> Sub-dural haematoma fluid in sub-dural space - heterogenous (old and new blood) - crescent outline esp in elderly, alcohol, ?minor trauma extra-dural - hyperdense, convex shape ? with fracture Multiple TIA think focal seizures - brain pathology or hypoglyc fixed critical stenosis - internal carotid (low BP) In TIA - usually know what they want to say even if they can't say it Beware of persisting Sx in TIA/stroke - esp sensory Sx, while motor ones clear Acute mild cerebral infarct - use antiHT LVH with HT - end organ damage - risk of failure, AF and sudden death start with ACE-ARB but prob need 2-3 drugs Look at British HT society website - guidelines Migraine basilar artery distribution Anticoagulate - 5/7 post mild TIA, 2/52 post stroke balance - risk of bleeding into new infarct vs risk of embolism degenerative spine - nerve root compression - pain monoparesis (only one limb) usually not TIA/stroke ''TIA Mx'' Clopidogrel, statin, ACE 90% of risk of MI and CVA (population level) Current smoker Unhealthy diet Physical inactivity Diabetes Psycho-social stress HT High Lipoprotein apoA/apoB ratio Abdo obesity Pathology TIA/CVA Embolism - thrombus / atheroma - carotid bifurcation or aortic arch thromboembolism (or tumour) left atrium or ventricle (AF) thrombosis circle of willis (small vessel disease in brain) ICA dissection - trauma or spontaneous venous thromboembolism through patent Foramen Ovale Dysdiadochokinesia ??? Labyrinthitis beware stroke or SOL TIA's seldom involve posterior circulation of brain (cerebellar signs) Amaurosis fugax - painless transient monocular visual loss embolic, hemodynamic, ocular, neuro, idiopathic Repeated identical transient neuro events - not usually TIA .... ?seizures, ?hypo-perfusion, ?functional Vascular Sx - pain and coldness Migraine No need to image often thought to be TIA Nerve compression injury Anxiety / functional disorder lots of attacks in short space with no impairment no red flags background of stressors need good explanation to pt Carpal tunnel - weakness with reduced co-ordination, numbness with pins and needles - thumb to ring finger associated with hypothyroid and acromegaly Ulnar nerve compression - elbow Sx, sensory change little finger, weakened grip Radial nerve damage - in mid arm, dorsum sensation and wrist extension affected Cortical hand (pre-central gyrus) - motor Sx - abduction and extension of index middle and ring fingers Subclavian steal - limb Sx (pallor, cold, blue, pain) with syncope when arm is used (blood reaches arm via circle of willis ....!!) Carotid disease starts with intimal thickening, then thick fibrous cap atheroma, in time the cap thins due to inflammation and may rupture / erode and then calcify ruptured / eroded - more likely to get thrombus and then embolism smoking, antiHT, antiplatelets, statins, may alter process plaque less stable in men cf women ''TIA mimics'' low BP, hypothermic, hypoglcaemic Demyelination - limb weakness, amaurosis fugax MRI - white matter lesions - blob - vascular lesion, linear - demyelination TIA - blood thinner, statin, antihypertensive remember driving Alexia - loss of reading ability, dominant lobe lesion often occipital Acalculia - loss of simple sums ability - lesion in parietal lobe (angular gyrus) Dysgraphia - difficulty writing - encode thoughts (parietal lobe (AG)) then transcribe words (frontal lobe (Exner's writing centre)) Migraine - may have deep hyperintense white matter changes on MRI Migraine with aura - increase risk of stroke esp if COCP (post circulation territory stroke) MRI may show changes with TIA - esp with higher ABCD2 score Carotid dissection - with Horners syndrome exposes subendothelial layer of artery and clot develops and lumen is narrowed Horners - eyelid drooping (ptosis) with pupil constriction (meiosis) ? dec sweating (anhydrosis), conjunctival redness, enophthalmos problem with sympathetic (autonomic) nerves Transient global amnesia - inability to store new info so repeated questioning, normal ADL, recognition of family, seldom recurs (think seizure) and last 2-4 hrs Bitemporal inferior quadrantanopia - superior optic chiasm Inferior homonymous quadrantanopia - parietal lobe Posterior circulation TIA vertigo ?? hearing loss Inter-arm differences in BP - caused by atherosclerosis causing obstructive arterial disease HT (use higher BP to guide treatment), DM, renal failure Carotid endarterectomy (mostly done under LA) higher degree of stenosis - more strokes saved unable to operate if completely occluded bells palsy LMN lesion of 7th cranial nerve eye rolls up and lateral when eyelid tries to close frontalis muscle is involved (unlike in UMN lesion when its spared) weakness persists whether voluntary (motor cortex) or involuntary (from emotion - ant cingulate cortex) while with UMN it is only on voluntary ear pain, tinnitus, headache, dizziness, impaired speech, loss of taste, numbness (trigeminal - not affected but weakness makes it feel odd) if some function recovered by 3/52 - likely to fully recover Mx - prednisolone, corneal lubrication if other CN lesions remember cerebellar-pontine angle tumour
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