Learning objectives
- Diagnose TOC strokes
- Investigations of TOC strokes
- Management of TOC strokes
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Introduction
- Top of the carotid at its bifurcation into ACA and MCA often called the carotid T
- The shape of the lumen is T is filled with clot - ICA/MCA/ACA
Aetiology
- Often embolic eg. AF
- Artery to artery from carotid thrombus - atherosclerois or dissection
- Other cardioembolic causes
- Left ventricular thrombus formation after acute myocardial infarction
- Cryptogenic stroke
Clinical
- ACA stroke syndrome
- MCA stroke syndrome
Investigations
- CT may show dense artery +/- evolved stroke
- MRI/A and CTA may show the occlusion
- Aetiology: ECG, Echo, 24/48/7 day tape for AF
Management
- Acute stroke care and reperfusion therapy - Thrombolysis and Thrombecotmy
- Admit HASU. See Hyperacute care.
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