Elderly Care and Stroke

Question 1

What does the Circle of WIllis look like?

Answer 1

Question 2

What are the branches of the ascending aorta?

Answer 2

Question 3

What is an anterior circulation stroke and what symptoms do they tend to cause?

Answer 3

This can be the ACA or MCA (TAC is both of PAC is one).

Tends to cause:

Hemiparesis (depending on side and artery)

Amaruosis fugax (ICA)

Aphasia

Dysphasia (Brocas area)

Question 4

What is an posterior circulation stroke and what symptoms do they tend to cause?

Answer 4

This is the PCA and tends to affect the brainstem and cerebellum.

It causes:

Dysarthria

Any CN disruption symptom eg vertigo, dysphagia

Tetraparesis

Question 9

What symptoms are common to anterior and posterior circulation strokes?

Answer 9

contralateral Sensory loss

contralateral Hemianopic visual loss

Question 10

Where are the two main sources of thrombus for stroke?

Answer 10

ICA

Heart

Question 11

What are the four characteristic symptoms of an Anterior Circulation Stroke? (ACS)

Answer 11

1. Weakness
2. Hemianopia
3. Dysphasia - Commonly if left sided affected. Can be receptive or expressive. Also affects reading and writing
4. Sensory Inattention

Question 12

What is the difference between a Total Anterior Circulation Stroke (TACI) and a PACI?

Answer 12

TACI - All cardinal symptons

PACI - 3/4 for right, 2/3 for left

Question 13

What are the characteristics of a cerebellar stroke?

Answer 13

Ipsalateral

DANISHPT

Question 14

What are the characteristics of a Lacunar Infarct (LACI)

Answer 14

All motor

Face, arms legs affected equaly

Question 15

What are the charcteristics of a brainstem stroke?

Answer 15

Locked in

CN dysfunction

Question 16

What is the protocol for initial stroke management?

Answer 16

• Maintain glucose, temp, 02 as normal
• Dont alter BP
• Give 300mg aspirin oral or rectal if haemorrhagic excluded
• Thromobysis (alteplace) is within 4.5 hours and haemorrhagic excluded radiologically
• Statins if cholesterol >3.5
• Anticoags started after haemorrhage excluded.

Question 17

What are some contraindications to thrombolsys?

Answer 17

• Intercranial tumour
• Seizure on onset
• Surgery or trauma in last 2 weeks
• Active bleeding
• Stroke or TBI within 3 months
• SAH

Question 18

What is the long term management for ischaemic stroke and tia?

Answer 18

1) Clopidigrel lifelong.
2) Aspirin and dypirimadole if contraindicated

Question 19

What is the long term management for ischaemic PAD?

Answer 19

1) clop lifelong
2) Aspirin if contraindicated

Question 20

What is the long term management for NSTEMI

Answer 20

1) Aspirin lifelong and clop 12 months
2) clop lifelong if contraindicated

Question 21

What is the long term management for STEMI

Answer 21

1) Aspirin lifelong and clop 12 months (1 month if no stent)
2) clop lifelong if contraindicated

Question 22

What can cause confusion?

Answer 22

CHIMPS PHONED + MORE

Constipation

Hypoxia

Infection

Metabolic disturbance

Pain

Sleeplessness

Presciption medicine

Hypothermia/pyrexia

Organs - hepatic or renal impairment

Nutrition

Environmental changes

Drugs

Question 23

What do you do in a confusion screen?

Answer 23

• Obs
• CT head
• Urine
• CXR
• Bloods - FBC, U+E, LFT, INR, Cultures, TFTS, calcium, B12 and folate, Glucose