clinmed2test3: TIA & Stroke ppt

Bell's Palsy

• Defined as an acute peripheral facial nerve palsy of unknown cause
• Represents about 50% of all cases of facial nerve palsy
• Risk is 3X higher during pregnancy
• Diabetics also have a higher risk
• Herpes simplex virus activation is the likely cause in most cases
• Herpes zoster is the 2nd most common viral infection associated with Bell's palsy
• Involves the facial nerve
• Symptoms appear rapidly (usually over hours) and range from mild to severe
• Symptoms include drooping eyelid or corner of mouth, difficulty making facial expressions, paralysis, drooling, excessive tearing, tingling in the eye, and impaired ability to taste (anterior ⅔ of tongue)
• Diagnosis includes diffuse facial nerve involvement, paralysis of facial muscles, with or without loss of taste on anterior 2/3 of tongue and altered secretion of lacrimal and salivary glands
• Onset is acute, progressive course, reaching maximal clinical weakness/paralysis within 3 weeks
• Recovery to some degree within 6 months
• Treatment involves short-term prednisone (glucocorticoid) therapy, eye care, physical therapy, and surgical decompression

Transient Ischemic Attack (TIA)

• Defined as a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction
• Symptoms are transient, short-lived, and often resolve prior to presentation
• Last less than 24 hours
• Symptoms mimic stroke
• Brain MRI is needed to determine if there was ischemia or not (TIA vs. Stroke)
• Evaluation involves the same workup as for stroke
• Patients with TIA are at increased risk of stroke

TIA/Stroke Evaluation

• MRI of the Brain
• Imaging of intracranial vessels (CTA head superior to MRA head)
• Evaluate for large vessel occlusion, significant intracranial atherosclerosis
• Imaging of extracranial vessels (CTA neck superior to MRA neck)
• Evaluate for dissection, symptomatic carotid stenosis
• Can also consider carotid ultrasound if CTA/MRA is not available

TIA/Stroke Secondary Prevention

• BP Control
• Permissive HTN for first 24-48 hours (unless stroke is ruled out)
• Lifestyle modifications (smoking cessation, substance counseling, weight loss, exercise, eval for sleep apnea)
• Antiplatelet therapy for non-cardioembolic TIA or stroke
• Anticoagulation therapy for cardioembolic TIA or stroke

Acute Ischemic Stroke: Treatment

• Reperfusion therapy includes two options: intravenous thrombolytic (tPA) and mechanical thrombectomy
• Immediate goal is to restore blood flow to the regions of the brain that are ischemic but not yet infarcted
• Long-term goal is to improve outcome by reducing stroke-related disability and mortality
• Alteplase: tissue plasminogen activator (tPA) initiated within 4.5 hours of clearly defined symptom onset