$Id: OUTLINE.txt,v 1.1 2004/05/17 11:31:35 adrian Exp adrian $ TIA ~~~ Stroke and transient ischaemic attacks Abbreviations: TIA: Transient ischaemic attack RIND: Reversible ischaemic neurological deficit CVA: Cerebro vascular accident Introdution Definition Acute derangement of neurological function with a presumed vascular cause Importance of time - Defecit lasts less than 24 hours (TIA) - Defecit lasts longer than 3-5 days (Stroke) - Defecit lasts 24 hours to 3--5 days (Reversible Ischaemic Neurological defecit) Differential diagnosis Haematological Anaemia Metabolic Hypoglycaemia Electrolyte derangement Acidosis Cardiogenic Valvular heart disease Aortic Stenosis Rhythm disorder Tachyarrythmias Bradyarrhythmias Embolic Extracranial vessels, especially origin of internal carotid Aortic arch Cardiac chambers Venous with patent septal defect and shunt Brain Mechanical Trauma Tumour, primary or secondary Infection Hydrocephalus Functional Epilepsy Anatomy Blood supply to the brain Circle of Willis Distribution of the internal carotid artery Opthalmic artery Middle cerebral Bottom of motor and sensory cortex (head and arm) Brocas area Anterior cerebral Top of motor and sensory cortex (leg) Distribution of the vertebral arteries Brain stem Cerebellum Occipital cortex Physiology Why we need a circulation Pond Carry pond Circulate the pond End artery Critical stenosis Relationship of distal bed to criticality - Walking and disappearing pulse - Papaverine test Nitrous Oxide (NO) Brachial artery reactivity Review of athermoma Causes of death in Ireland Major killer is cardio-vascular with most of this due to athermoatous disease of the coronary arteries Contributors to atheroma Familial High cholesterol Diabetes Hypothyroidism High blood pressure Cigarettes How atheroma causes problems Plaque Plaque rupture with embolisation Plaque ulceration with platelet clot and embolisation Haemorrhage into plaque with acute vessel occlusion Narrow vessel with poor flow distally Clinical presentation Asymptomatic - Cervical Bruit Asymptomatic - Brain injury seen on scan for some other reason Symptomatic +/- brain injury seen on scan - Clinical amaurosis or amblyopia Amaurosis Fugax (Ocular TIA) - Clinical transient ischaemic attack (effect lasts less than 24 hours) TIA (Hemispherical TIA) Monoplegia Hemiplegia Hemianaesthesia - Clinical RIND or CVA - Funny turn (c) Adrian P. Ireland, 2004. Released under the Gnu Free Documentation Licence % vim: set ai tw=78: