Atypical Strokes and GBS

Question 1

Causes of strokes

-source of ischemia

Answer 1

Hemorrhagic -

• Aneurysm => bleed into SA space - thunderclap headache, hit on head with bat
• Dissection => tearing of the vessels (due to HTN, Marfans, EDS, trauma) => localised pain

Ischemic - emboli, thrombi
-AF, carotid stenosis, valvular defects => assessed by Echo and ECG

Question 2

Dissection

• age group
• causes
• pathophysiology and how it causes stroke
• presentation

Answer 2

Most common cause of stroke in young

• trauma
• connective tissue disorder (Marfans, EDS)

Damage between the intima - media

• intima can prolapse => complete occlusion of vessel
• irregular inner vessel surface => thromboembolus

Tearing => localised pain
-Horners => partial ptosis due to compression of sympathetic nerves hitchhiking along carotid arteries

Can take days-weeks => stroke
-important to find this before it happens - trauma within past week

Question 3

Horner’s syndrome in relation to strokes

Answer 3

Originate from T1-6 => sympathetic chain (sup, middle, inf cervical ganglia alongside vertebral bodies) => ascend up into H+N by wrapping around the carotids and arteries

Horners - any disturbance in the sympathetic nerves
-unilateral partial ptosis, constriction of pupil, anhidrosis

Complete ptosis - III + dilated pupil,

Question 4

Investigations to assess for dissection prestroke

Answer 4

FBC, UE, CRP
CT Head
LP
CT angio of head AND neck
MRI head and orbits with contrast

Question 5

Guillain Barre

• pathophysiology and mimics
• presentation

Answer 5

Acute inflammatory demyelinated neuropathy - up to 3 months post infection
-GBS

Chronic inflammatory demyelinated neuropathy - 3 months + post infection

Muscle weakness => affects PNS SNS

• function of diaphragm at night, cardiac
• assess ABG
• facial palsy => choking, aspiration, speech, appearance

Question 6

CSF protein banding

Answer 6

Monoclonal bands - myeloma!
Oligoclonal bands - MS
Polyclonal bands - nothing significant

High protein+cells in active infection (low glucose)
Cells decrease post infection but protein stays due to inflammation (cytoalbuminemic dissociation)
Nor

Question 7

Nerve conduction studies

Answer 7

Demyelination => speed of impulse is slower, AP is same size
-but you need a significant amount of loss to give you a positive result for GBS
Axon dies => AP is lower

Question 8

Management of ischemic strokes

Answer 8

CT head, angiogram of neck and cranial vessels - is it ischemic or hemorrhagic
U4.5hrs => stroke thrombolysis
U6hrs => thrombectomy

Question 9

What is NIHSS

-interpretation of results

Answer 9

0 - no stroke
1-4 - minor 
5-15 - moderate
16-20 - moderate/severe
21+ - severe