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Questions for part B
Published in Henry J. Woodford, Essential Geriatrics, 2022
A 73-year-old woman has been admitted to the stroke unit following a left partial anterior circulation infarct. Prior to admission she had no significant past medical history and was taking no regular medications. An ECG at admission found her to be in atrial fibrillation. She has been started on aspirin 300 mg daily and is making progress in rehabilitation. Now three days into her recovery, she has some persisting right-sided weakness and speech disturbance. She is to continue rehabilitation on the specialist unit. A what time would it be appropriate to switch her from aspirin to an oral anticoagulant drug?If no haemorrhage is seen on brain imaging four weeks after stroke onsetImmediatelyOne week from stroke onsetOnly if she has a further cerebrovascular eventTwo weeks from stroke onset
Stroke and Transient Ischemic Attacks of the Brain and Eye
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
TTE should be considered particularly for patients in whom a proximal source of embolism in the heart or aortic arch is suspected, such as those with a nonlacunar stroke syndrome (e.g. total anterior circulation infarct [TACI], partial anterior circulation infarct [PACI], or POCI, which are all commonly caused by embolic occlusion of a cerebral artery), an abnormal heart clinically, and abnormal ECG or chest X-ray, and a CT or MRI brain scan showing wedge-shaped cortical–subcortical cerebral infarction, particularly if there are multiple brain infarcts and in different arterial territories (Figures 12.145, 12.146). TTE also may identify a PFO (Figures 12.186, 12.187) or valve vegetations due to infective endocarditis (Figure 12.188).
Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Depending on how many of these features are present, four possible syndromes are possible. Total anterior circulation infarct (TACI): 10–20% strokes – worst prognosisPartial anterior circulation infarct (PACI): 30–40% strokesPosterior circulation infarct (POCI): 20–30% strokesLacunar infarct: 20–30% pure motor, pure sensory, ataxic hemiparesis
Sex- related differences in the factors associated with outcomes among patients with strokes of undetermined source: a hospital-based follow-up study
Published in Postgraduate Medicine, 2021
Lili Yan, Chunmei Huangfu, Na Yang, Renzi Li, Xiuping Yang, Yujing Feng, Lihui Xuan, Qian Wang, Yanhong Meng, Xiaoqiang Hou, Xuemei Li
Patients were categorized into five age groups: <45 years, 45–54 years, 55–64 years, 65–74 years, and ≥75 years. The OCSP classification criteria divided the strokes into four subtypes: total anterior circulation infarct, partial anterior circulation infarct, posterior circulation infarct, and lacunar infarct. Stroke severity was also categorized according to the NIHSS scores as: mild (NIHSS score, ≤7), moderate (8–16), or severe (≥17). Hypertension was defined as patient-reported history of hypertension, systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, or receiving hypertension drugs; diabetes mellitus was defined as patient-reported history of diabetes, FPG levels ≥7 mmol/L, or use of antidiabetic medication; hyperlipidemia was defined as patient-reported history of hyperlipidemia, TC > 6.22 mmol/L, LDL-C level > 4.14 mmol/L, TG level > 2.26 mmol/L, or use of oral lipid-lowering medicine [24]; atrial fibrillation was defined as patient-reported history of atrial fibrillation or the presence of arrhythmia detected using 12-lead electrocardiography or 24-hour Holter rhythm monitoring during hospitalization; obesity was defined as a BMI ≥28 kg/m2 [25]; smoking was defined as smoking at least one cigarette/day for >1 year; and alcohol consumption was defined as drinking alcohol at least once/week for >1 year.