Clinical introduction to Stroke

Question 1

Comment on epidemiology, symptoms, progression,

25 year old female, right-sided visual bright spots followed by gradual onset of severe unilateral pulsating headache associated with nausea and right-sided arm numbness

Answer 1

Epidemiology → Px → 25 unlikely, female (pre-menopausal) unlikely

Symptoms → bright spots

• Ischaemic strokes → usually negative symptoms (e.g. lack of vision). In this case, we’re getting extra symptoms
• Sounds a lot more like a migraine
• Also possible to get migraines with motor and speech disturbances.

REM: Most strokes don’t give you headaches acutely (for ischaemic, haemorrhagic might)

Migraines → cortical depression spread, effects start from one part of the brain and then spread throughout

Question 2

Epidemiology? progression? possible diagnosis?

64 year old man with 3-month history of progressive right-hand weakness associated with a mild headache in the morning

Answer 2

Epidemiology → looks appropriate

But progession suggests otherwise

Possible diagnosis:

• Probably space occupying lesion (presentation → worse in the morning)

Question 3

34 year old man with history of epilepsy developed left-sided facial droop and arm weakness following a 1 minute generalised tonic-clonic seizure

Name the diagnosis?

Answer 3

Age = less likely stroke

History of epilepsy

Todds Paresis/ paralysis → when person with a focal seizure develops weakness afterwards; therory = seizure focus becomes hyperexcitable w/ following period of hypoexcitability

Question 4

83 year old female with 2 day history of lethargy, drowsiness and fevers develop speechdisturbance and right arm weakness

Question 5

Define Stroke

Answer 5

Rapid development of

focal neurological deficit caused