Build Up to STROKE

Question 1

STROKE definition

Answer 1

✨ Abrupt onset of FOCAL NEUROLOGICAL DEFICIT
✨ which is DUE TO: Acute Focal HYPOPERFUSION (Duration > 24hrs)
✨ DUE TO VASCULAR ISSUE which can be DUE TO:
🎯 Thrombosis
🎯 Thromboembolism DUE TO:
✨ Artery to Artery Thromboembolism
✨ Cardioembolism (AFib)

Question 2

Difference BETWEEN STROKE & TIA

Answer 2

TIA lasts < 24 hours

Question 3

⭐ Very SUDDEN ONSET STROKE, most likely cause?

⭐ STROKE in Progression, most likely cause?

Answer 3

⭐ Very SUDDEN ONSET STROKE, most likely cause?
🎯 CARDIOEMBOLIC STROKE

⭐ STROKE in Progression, most likely cause?
🎯 THROMBOTIC STROKE
🎯 ARTERY TO ARTERY THROMBOEMBOLIC STROKE

Question 4

⭐ Stroke presenting as LOSS of CONSCIOUSNESS & SEIZURES. MOST PROBABLE CAUSE

⭐ Stroke presenting as Increasing Headache. MOST PROBABLE CAUSE

Answer 4

⭐ Stroke presenting as LOSS of CONSCIOUSNESS & SEIZURES. MOST PROBABLE CAUSE
🎯 CARDIOEMBOLIC STROKE

⭐ Stroke presenting as Increasing Headache. MOST PROBABLE CAUSE
🎯 THROMBOTIC STROKE
🎯 THROMBOEMBOLIC STROKE

Question 5

⭐ Stroke with FULL WEAKNESS at ONSET. MOST PROBABLE CAUSE

⭐ Stroke with Progessive WEAKNESS within 48-72hrs. MOST PROBABLE CAUSE

Answer 5

⭐ Stroke with FULL WEAKNESS at ONSET. MOST PROBABLE CAUSE
🎯 CARDIOEMBOLIC STROKE

⭐ Stroke with Progessive WEAKNESS within 48-72hrs. MOST PROBABLE CAUSE
🎯 THROMBOTIC STROKE
🎯 THROMBOEMBOLIC STROKE

Question 6

⭐ Stroke with RED HEMORRHAGIC CLOT MOST PROBABLE CAUSE

⭐ Stroke with FIBRIN CLOT. MOST PROBABLE CAUSE

Answer 6

⭐ Stroke with RED HEMORRHAGIC CLOT MOST PROBABLE CAUSE
🎯 CARDIOEMBOLIC STROKE

⭐ Stroke with FIBRIN CLOT. MOST PROBABLE CAUSE
🎯 THROMBOTIC STROKE
🎯 THROMBOEMBOLIC STROKE

Question 7

🌸 TYPES of STROKE
⭐ Based on Etiology
⭐ Based on Vessel involvement

Answer 7

⭐ Based on Etiology
1. Ischemic STROKE 85%
2. HEMORRHAGIC STROKE 15%

⭐ Based on Vessel involvement
1. Arterial 95%
2. Venous 1-5%

Question 8

1st INVESTIGATION to do in a patient of STROKE

Answer 8

🎯 CT (to look for Bleeding)
⬇️
🎯 DWMRI Diffusion weighted MRI (To look for INFARCTION)
🎯 ADA MRI
🎯 Perfusion weighted MRI

Question 9

CT shows NO BLEEDING in

Answer 9

First 24-48hrs

Question 10

New definition of TIA

Answer 10

🎯 DW-MRI NORMAL ➕ REVERSED Dysfunction

A brief episode of NEUROLOGICAL Dysfunction caused by FOCAL BRAIN, Spinal Cord or Retinal Ischemia with clinical symptoms WITHOUT EVIDENCE of INFARCTION

Question 11

Repeated Episodes of TIA
➕
Headache
➕
Amaurosis FUGAX
is classically ASSOCIATED with

Answer 11

INTERNAL CAROTID ARTERY Stroke

Question 12

MAXIMUM RISK of Final STROKE after a TIA

Answer 12

Next 48 hours

Question 13

Anterior Circulation TIA ASSOCIATED with

Answer 13

1. Amaurosis Fugax
2. C/L Weakness
3. C/L Homonymous Hemianopia
4. Aphasia

Question 14

Posterior Circulation TIA ASSOCIATED with

Answer 14

1. Crossed HEMIPLEGIA
2. Lower CN palsy

Question 15

Risk of STROKE Following TIA is measured by

Answer 15

1. ABCD² Score

Question 16

ABCD² Score

Answer 16

Age ≥ 60
Blood pressure > 140/90
Clinical Features of TIA
✨ Unilateral weakness 2
✨ Speech disturbance w/o weakness 1
Duration of symptoms
> 10 min-59 min: 1
≥ 60 min: 2
Diabetes

Question 17

Interpretation of ABCD² Score

Answer 17

Low Risk: 0-3
Moderate Risk: 4-5
High Risk: 6-7

Question 18

TOAST Classification used for

Question 19

Watershed Zones of Brain

Question 20

TOAST Classification

Question 21

⭐ Cause of VENOUS STROKE (CVT)

⭐ Cause of ARTERIAL STROKE

Answer 21

⭐ Cause of VENOUS STROKE (CVT)
🎯 HYPERCOAGULABLE STATE

⭐ Cause of ARTERIAL STROKE
🎯 15%: Hemorrhagic Stroke: ICH > SAH
🎯 85%: ISCHEMIC Stroke

Question 22

⚡⚡ MOST COMMON TYPE OF STROKE WORLDWIDE

⚡⚡ MOST COMMON TYPE OF STROKE IN INDIA

Answer 22

⚡⚡ MOST COMMON TYPE OF STROKE WORLDWIDE
🎯 CARDIOEMBOLIC STROKE

⚡⚡ MOST COMMON TYPE OF STROKE IN INDIA
🎯 ARTERY TO ARTERY EMBOLIC STROKE (Mostly from Carotid artery)

Question 23

NIHS SCORE used for

Answer 23

Stroke

Question 24

Pathogenesis of STROKE

Answer 24

🎯 CEREBRAL AUTOREGULATION FAILURE

Question 25

HEMORRHAGIC transformation is characteristic of

Answer 25

CARDIOEMBOLIC STROKE

Question 26

EARLY SIGNS of STROKE in CT

Answer 26

1. Hyperdense MCA sign (within 6 hrs)
2. Insular Ribbon Sign: Loss of Grey White Matter differentiation at Insule (6-48hrs)
3. Obscuration of Lentiform nucleus

Question 27

Causes OF THROMBOTIC STROKE

Answer 27

🎯 THROMBOSIS of LARGE VESSELS
✨ Atherosclerosis (Hypertension > DM)
✨ Aortic Dissection
✨ Takayasu arteritis
✨ FMD
✨ APLA

Question 28

High RISK CARDIAC Disease for Stroke

Answer 28

1. Atrial Fibrillation
2. MS & AS (can cause A fib)
3. Prosthetic valves
4. Sick Sinus Syndrome
5. Recent MI
6. DILATED cardiomyopathy

Question 29

⚡⚡ MOST IMPORTANT ⚒️ RISK FACTOR for STROKE

Answer 29

1. HYPERTENSION
2. Atrial Fibrillation
3. Carotid Stenosis

Question 30

Small Vessel Stroke is known as

Answer 30

LACUNAR STROKE

Question 31

LACUNAR INFARCTION

Answer 31

✨ Lipo-hyalinotic OCCLUSION of
✨ 30-300 micron vessel with
✨ 3mm to 2cm INFARCTION

Question 32

Lacunar stroke Seen in

⚡⚡ MOST IMPORTANT RISK FACTOR for LACUNAR STROKE

Answer 32

Elderly ♀️ > ♂️

⭐ HYPERTENSION

Question 33

Manifestation of LACUNAR STROKE

Answer 33

1. Pure Motor Hemiparesis
2. Pure Sensory Hemiparesis
3. Dysarthria with Clumsy Hand
4. Ataxic Hemiparesis
5. Sensorimotor Hemiparesis

Question 34

⭐ PURE MOTOR LACUNAR STROKE Occurs DUE to INVOLVEMENT of

⭐ PURE SENSORY LACUNAR STROKE Occurs DUE to INVOLVEMENT of

Answer 34

⭐ PURE MOTOR LACUNAR STROKE Occurs DUE to INVOLVEMENT of
🎯 Lenticulo-striate BRANCH of MCA
✨ INTERNAL CAPSULE

⭐ PURE SENSORY LACUNAR STROKE Occurs DUE to INVOLVEMENT of
🎯 Small Thalamo-Perforaters of PCA
(OR) Lenticulostriate branch of MCA
✨ VPL Thalamus

Question 35

Ataxic HEMIPARESIS DUE TO

⭐ LESION at
⭐ VESSELS Involved

Answer 35

⭐ Basipontine lesion
(OR)
Internal Capsule

⭐ Perforaters of BASILAR ARTERY

Question 36

Dysarthria with Clumsy Hand

⭐ LESION at
⭐ VESSELS Involved

Answer 36

⭐ Basipontine lesion

⭐ Perforaters of BASILAR ARTERY

Question 37

Development of ATAXIC HEMIPARESIS

Answer 37

⭐ LESION at BASIPONTINE Region
⬇️
✨ Hemiparesis: Corticospinal Tract damaged (CST)
✨ Ataxia: Cortico-ponto-cerbellar pathway

Both on OPPOSITE SIDE

Question 38

Dysarthria with Clumsy Hand

Answer 38

Cerebellar Ataxia
(slow scanning Staccoto Speech)