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This is a short episode walking through and reviewing the content we covered last week.
Here’s the formatted blog post for easy readability:
Stroke vs. TIA: Key Differentiators
Symptom Duration
- TIA: Symptoms fully resolve within 24 hours.
- Stroke: Symptoms persist beyond 24 hours.
Headache Severity and Acuity
- Hemorrhagic Stroke:
- Often presents with severe headache, vomiting, and rapid decline in consciousness.
- Ischemic Stroke:
- More likely to show focal neurologic deficits without an extreme headache.
- TIA:
- May have a mild headache or none, but deficits resolve quickly.
Imaging Findings
- Hemorrhagic Stroke (CT):
- Shows hyperdense (bright white) areas indicating bleeding.
- Ischemic Stroke (CT/MRI):
- Appears as dark or low attenuation areas on CT (may take hours to appear).
- MRI may show diffusion restriction.
- TIA:
- Imaging is typically normal (no permanent lesion).
Treatments
TIA
- Short-term dual antiplatelet therapy is often used to prevent stroke recurrence.
- Long-term therapy depends on the underlying cause (atherothrombotic vs. cardioembolic).
Ischemic Stroke
- IV tPA (within the time window and no contraindications) is first-line therapy.
- Mechanical thrombectomy is indicated for large vessel occlusions.
Hemorrhagic Stroke
- Rapid BP control
- Reversing anticoagulation
- Managing intracranial pressure
- Neurosurgical interventions may be necessary for large bleeds or aneurysm repair.
The Final Step Style Questions
- What is the time cutoff for symptoms to resolve and still be classified as a TIA?
- Which imaging study is first-line to identify an intracranial hemorrhage?
- List one medication used to lower intracranial pressure in hemorrhagic stroke.
- Name the gold-standard imaging modality for identifying ischemic stroke.
- What percentage of strokes are ischemic versus hemorrhagic?
- Give one example of a potential cause for a hemorrhagic stroke.
- Identify one modifiable risk factor for TIA and stroke.
PANCE Stye Questions
Question 1
A 68-year-old woman experiences sudden onset of right-arm weakness and difficulty speaking. The symptoms completely resolve within 6 hours with no residual deficits. Which of the following time frames defines the cutoff for diagnosing a transient ischemic attack (TIA) rather than a stroke?
Answer Choices
A. Within 12 hours
B. Within 24 hours
C. Within 48 hours
D. Within 72 hours
Question 2
A 60-year-old man is brought to the ER with altered mental status and headache described as “the worst of his life.” On exam, his blood pressure is 190/110 mmHg, and he shows left-sided weakness. Which initial imaging study is most appropriate to rapidly identify or rule out an intracranial hemorrhage?
Answer Choices
A. Carotid ultrasound
B. Non-contrast CT scan of the head
C. MRI of the brain with contrast
D. CT angiography of the head and neck
Question 3
A 67-year-old man presents with sudden-onset left-sided weakness and mild headache. His blood pressure is 190/110 mmHg on arrival. A non-contrast CT scan of the head shows no signs of hemorrhage. It has been 2 hours since symptom onset. Which of the following is the most appropriate next step in management?
Answer Choices
A. Give aspirin and observe for 24 hours
B. Control blood pressure to <185/110 mmHg and administer IV tPA
C. Proceed with mechanical thrombectomy
D. Perform lumbar puncture to rule out subarachnoid hemorrhage
Question 4
A 55-year-old woman with a history of atrial fibrillation presents with sudden onset of right-sided arm weakness and speech difficulty that resolved within 30 minutes. A carotid ultrasound shows 65% stenosis in her left internal carotid artery. Non-contrast head CT is unremarkable. Which of the following is the most appropriate next step in management?
Answer Choices
A. Begin dual antiplatelet therapy with aspirin and clopidogrel
B. Initiate anticoagulation with heparin, bridging to warfarin
C. Schedule a carotid endarterectomy
D. Obtain MRI of the brain before initiating therapy
