CVA

Question 1

What are the common examination findings?

Answer 1

NB - CONTRALATERAL SIGNS

• Tone - Increased on affected side
• Power - Decreased on affected side
• Reflexes - Hyperreflexic on affected side
• Sensation - Usually intact
• Coordiantion - Normal but power may hinder it
• Vision - may have contralateral hemianopia

May have contractures on affected side

Question 2

What are the signs of an UMN in the face?

Answer 2

Forehead sparing weakness

Question 3

What are the classifications of stroke?

Answer 3

TACI - Anterior and middle cerebral arteries

• Hemianopia
• higher dysfunction (dysphasia)
• Hemiparesis

PACI - MCA

• Higher dysfunction or the other 2

Posterior - PCA

• Only hemineglect
• Cranial nerve signs

Lacunar

Purely motor or purely sensory

Brain stem

Mixed signs

Question 4

What are the investigations?

Answer 4

To finish the exam i would like to do - Upper/lower limb exam and cranial nerves

By the bed - History, obs

Bloods - FBC, U/E, Glucose to exclude hypoglycaemia/ lipid profile/clotting

Other - ECG (?Af) CT Scan within 8 hours or LP after 12, carotid doppler

Question 5

What are the key investigation findings?

Answer 5

SIgns of bleed or infarct on CT

Question 6

What is the treatment?

Answer 6

Acute

• If haemorrhage excluded then thrombolyse within 4.5 hours
• If haemorrhage reverse anticoagulation
• Admit to inpatient stroke ward for MDT assessment

Later:

• Conservative - minimise risk factors
• Medical - Clopidogrel and statin lifelong
• OT input and physio
  *

Question 7

What are the risk factors?

Answer 7

Ischaemic:

Obesity

Smoking

Alcohol

Familial hyperliidpaemia

AF

Haemorrhagic:

Anti coagulation

Question 8

How do you differentiate clinically between haemorrhage and infarct?

Answer 8

Haemorrhage - headache, loss of consciousness, coma