Cerebrovascular disease

Question 1

What assessment tool should be used in A&E to determine whether patient has likely had a stroke or not?

Answer 1

The ROSIER score

Question 2

How is CT used to determine which type of stroke a patient has had?

Answer 2

Poor at picking up acute ischaemic lesions but can clearly show haemorrhagic lesions

Question 3

What four components should be used to describe a stroke?

Answer 3

Type of stroke

Size of stroke

Laterality of stoke

Cause of stroke

Question 4

Which is the most severe type of stroke?

Answer 4

Total anterior circulation

Question 5

What are the symptoms of a total anterior circulation stroke?

Answer 5

Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss

Homonymous Hemianopia

Cortical signs (dysphasia, neglect etc)

Question 6

What are the symptoms of a partial anterior circulation stroke?

Answer 6

2 out of 3 features of:

Higher dysfunction - dysphasia or visuospatial disturbances

Homonymous hemianopia

Motor and Sensory Defects (>2/3 of face, arm, leg)

Or:

Higher dysfunction alone

Partial motor or sensory defect

Question 7

What areas of the brain may be affected by a lacunar stroke?

Answer 7

Basal ganglia

Thalamus

White matter

Internal capsule

Question 8

What is the most common type of lacunar stroke?

Answer 8

Pure motor stroke/hemiparesis

Usually occurs with infarction of the posterior limb of the internal capsule, which carries the descending corticospinal tracts

Question 9

Which type of stroke has the best prognosis?

Answer 9

Lacunar stroke

Question 10

What symptoms might be caused by a posterior circulation stroke?

Answer 10

Cranial nerve palsies

Bilateral motor and/or sensory deficits

Conjugate eye movement disorders

Isolated homonymous hemianopia

Cortical blindness

Cerebellar deficits without ipsilateral motor/sensory signs

Question 11

Which hemisphere is dominant in most people?

Answer 11

Left hemisphere

Question 12

Which side of the body will be affected by a stroke in the left hemisphere?

Answer 12

Right side

Question 13

Which side of the body will be affected by a stroke in the right hemisphere?

Answer 13

Left side

Question 14

What higher functions does the left hemisphere of the brain have?

Answer 14

Spoken language

Reasoning

Number skills

Written language

Question 15

What higher functions does the right side of the brain have?

Answer 15

Music

Creativity

Spacial orientation

Question 16

What might a CVA in the dominant hemisphere cause?

Answer 16

Defecits in language (Brocas and Wernickes areas)

Question 17

What might a CVA in the non-dominant hemisphere cause?

Answer 17

Neglect - spacial awareness

Question 18

What is the more common type of stroke?

Answer 18

Ischaemic

Question 19

What is the most common cause of cardioembolic origin of stroke?

Answer 19

Atrial fibrillation

Question 20

What investigations should be done to detect thromboembolic stroke?

Answer 20

Full Lipid Profile

Blood Pressure

Carotid Scan

ECG

Question 21

What are the two main causes of ischaemic stroke?

Answer 21

Thrombosis i.e. from atherosclerotic carotid

Embolism of cardiac origin i.e. AF, infective endocarditis, prosthetic heart valve

Question 22

What are the causes of haemorrhagic stroke?

Answer 22

Hypertension

Arteriovenous malformation

Cocaine/amphetamine use

Trauma

Question 23

What score is used to determine risk of subsequent stroke following TIA?

Answer 23

ABCD2