Clinical Considerations

Question 1

What is the atraumatic vascular event which is attributed to 85% of stokes? And what is the other variation?

Answer 1

85% Ischaemic Stroke

15% Haemorrhagic - Including Sub-Arachnoid Haemorrhage

Extra-dural and Sub-dural Haemorrhages are not include

Question 2

What are the cardinal features of stroke?

Answer 2

Focal clinical deficits

Negative clinical phenomena - i.e. limp instead of hypercontracted

Relate to arterial anatomy

Sudden onset - bursting of a blood vessel

Identifiable risk factors

Question 3

Do non-motor hemisphere deficits manifest on the ipsilateral or contralateral side?

Answer 3

Contralateral

Question 4

How would a primary intracranial haemorrhage present?

Answer 4

Hyperacute

Headache

Sudden rise in pressure in the skull → LoC

Cushing reflex

Question 5

Describe the Cushing reflex.

Answer 5

Increased intra-cranial pressure → heart working at such a high pressure → Slow down

Question 6

What are the signs for a subarachnoid haemorrhage?

Answer 6

Very sudden headache; Peak within 2 minutes - Thunderclap headache

Meningism - blood irritates brain lining

Photophobia and stiff neck

Sudden rise in pressure → LoC

Cushing Reflex

Question 7

Describe cerebral venous sinus thrombosis

Answer 7

DVT of the brain

Sub-acute, secondary bleeding - block vein off → bit of back pressure → bleed into stroke, raised ICP

No respect for arterial territories

Question 8

How would a patient describe their symptoms if they had Amaurosis Fugax? And what is it?

Answer 8

Curtain falling down on one eye.

Series of emboli moving through retinal circulation - suggestive of left carotid

Question 9

What are the risk factors for TIA?

Answer 9

Age >60

Blood pressure >140/90

Diabetes

Question 10

What are the cardinal clinical features of TIA?

Answer 10

Hemiparesis +/- speech