University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

67

Pages:

2
Author:

Mariam A.

Transient ischaemic attack Lecture Notes     Stroke symptoms that last <24 hours before disappearing. Generally do not cause permanent brain damage. Serious warning signs of stroke and should not be ignored. Usually caused by either: o Low blood flow at a narrow part of a major artery carrying blood to the brain, such as the carotid artery. o A blood clot in another part of the body (e.g. heart) that breaks off and travels to the brain to block blood vessels. o Narrowing of smaller blood vessels in the brain, blocking blood flow for a short period of time, usually caused by plaque buildup. Warning signs Investigations  ECG/Holter ECG. o To check for atrial fibrillation. o Holter ECG is performed for a long period of time. Used because it will allow detection of atrial fibrillation when it occurs.  Echocardiogram. o To check if there are any clots in the heart.  Carotid Doppler study.     o To check for blocked or reduced blood flow at the carotid arteries. CT scan. o Allows detection of haemorrhage. o Diffuse CT: can see how much blood is being lost, and how much is being retained. CT angiography. MRI scan. o Much more accurate than CT scan. MR angiography. Management  Ischaemic penumbra: o Vulnerable brain tissue surrounding the area of necrosis. o Tissue is at risk and may die if blood flow is not restored. o Subsequent cell death may be a result of toxic metabolites produce by the ischaemic tissue or even oedema surrounding the infarct core. o Thus, role of treatment is to preserve ischaemic penumbra.     TPA: o Thrombolytic therapy break up or dissolve blood clots, which are the main cause of both heart attacks and stroke. o Recombinant tissue plasminogen activator (r-tPA), alteplase, is FDA-approved for treatment of acute ischaemic stroke. o Giving thrombolytics within 4.5 hours of the first stroke symptoms can help limit stroke damage and disability. o However, using thrombolytic therapy in cases of haemorrhagic stroke is dangerous as it increases the amount of blood that contributes to the haematoma. Carotid endarterectomy: o Used to treat plaque. Coil procedure: o Used to treat subarachnoid aneurysms before haemorrhage. o Coil is guided from the groin area into the clot. Decompressive hemicraniectomy: o Drill out section of skull. o Allows brain to swell to relieve intracranial pressure. o Helps to survive stroke, but does not help with regaining function.