4 - Stroke Syndromes Flashcards
What are the questions that need you need to ask yourself when a patient is having a stroke?
- Is it a stroke and what syndrome is it?
- What is the aetiology?
- Are there any complications?
- What treatment does this patient need and when?
- How well is this patient likely to do?
- When can they leave our care?
What is a stroke and the two main categories of this?
Sudden onset focal neurological deficit of vascular aetiology, with symptoms lasting >24 hours (or with evidence of infarction on imaging)
Ischaemic (85%) or Haemorraghic (15%)
Due to abnormal cerebral perfusion
How are Haemorraghic and Ischaemic strokes further divided?
Ischaemic: Bamford/Oxford classification
Haemorraghic (bleeding into parenchyma, ventricles or subarachnoid space): ICH or SAH
What are the causes of ischaemic and haemorraghic strokes?
Ischaemic: Thrombosis, Emboli (AF!), Dissection
Haemorraghic: HTN, brain tumour, vasculitis, bleeding disorders, trauma
What are some risk factors for a stroke?
Strong risks: male, FHx hypertension, smoking, diabetes, AF
Weak risks: hypercholesterolaemia, obesity, poor diet, oestrogen-containing therapy, and migraine.
What is the Circle of Willis made up of and what lobes of the brain do the 3 main cerebral arteries supply?
(Draw image of Circle of Willis)
Anterior Circulation: ICA
Posterior Circulation: Vertebrobasillar system
ACA: medial frontal and parietal lobes
MCA: lateral surface of each brain hemisphere including the internal capsule and basal ganglia
PCA: occipital lobe and inferior temporal lobe as well as some deep structures (e.g. thalamus)
What is the blood supply to cerebellum?
What are the three most common causes of ischaemic stroke?
- Large artery atherosclerosis (emboli)
- Small artery atherosclerosis (thrombus)
- Cardioembolic (AF)
Rare: vasculitis, dissection
What is a TACS stroke?
Ischaemic Total Anterior Circulation Stroke (3/3)
- Contralateral hemiplegia or hemiparesis, AND
- Contralateral homonymous hemianopia, AND
- Higher cerebral dysfunction (e.g. aphasia, neglect)
Involves MCA or ACA
What is a PACS stroke?
Ischaemic Partial Anterior Circulation Stroke (⅔)
ACA or MCA
What is a LACS/Lacunar stroke and what vessel is affected?
Should be no visual defects, no higher cerebral dysfunction and no brainstem dysfunction
Affects deep perforating arteries, usually supplying internal capsule
What is a POCS stroke and what vessel is affected?
Ischaemic posterior circulation syndrome
Involves vertebrobasilar arteries and associated branches (supplying the cerebellum, brainstem, and occipital lobe)
- Cerebellar dysfunction, OR
- Conjugate eye movement disorder, OR
- Bilateral motor/sensory deficit, OR
- Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit, OR
- Cortical blidness/isolated hemianopia.
How may someone with a haemorraghic stroke present?
- Headache
- Altered mental status
- Nausea & Vomiting
- Hypertension
- Seizures
- Focal neurological deficits (dependent on location of bleed)
How may someone with an anterior ischaemic stroke present?
Depends on location of infarct
- Unilateral weakness and/or sensory deficit: face and/or arms and/or legs
- Homonymous hemianopia: visual field loss on the same side of both eyes
- Higher cerebral dysfunction: dysphasia, visuospatial dysfunction (e.g. neglect, agnosia)
How may someone with a posterior ischaemic stroke present?
Affects brainstem, cerebellum and occipital lobe so balance/visual/cranial nerve issues:
- Dizziness
- Diplopia
- Dysarthria & Dysphagia
- Ataxia
- Visual Field defects
- Brainstem syndromes: often seen with crossed signs (*ipsilateral cranial nerve lesions with contralateral sensory and motor limb deficits)
What are posterior stroke syndromes and some examples of these?
Syndromes that occur due to infarction of specific posterior circulation arteries
- Wallenburg syndrome
- Locked-in syndrome
- Weber’s syndrome
- Lateral pontine syndrome
What is Wallenburg syndrome and what vessel is affected?
- Posterior inferior cerebellar artery occlusion
- Lateral medullary syndrome
- Symptoms: ipsilateral Horner’s syndrome, ipsilateral loss of pain and temperature sensation on the face, and contralateral loss of pain and temperature sensation over the contralateral body, nystagmus, vertigo, diplopia
What is Locked In syndrome and what vessel is affected?
- Basillar artery occlusion
- Quadriparesis with preserved consciousness and ocular movements
Often this type of occlusion leads to sudden death or LOC