General

Question 1

What is a lacuna stroke?

Answer 1

Extravasation through the vascular endothelium (BBB) in terminal arteries into perivascular space (usually white matter) up to 2cm in diameter. Very likely to reoccur.

Question 2

What are the risk factors for stroke?

Answer 2

High BP

Smoking

Alcohol

Diabetes

High cholesterol

Age

Obesity

AF

Question 3

What are border/watershed zones?

Answer 3

Areas at the extremities of 2 arterial supplies.

THey are the first to become hypoperfused if BP is too low

Question 4

Possible territories and symptoms of ACA occlusion?

Answer 4

• Orbital and Frontal areas - Apathy and memory loss
• LL weakness more significant than UL

Question 5

Possible areas and symptoms of MCA stroke

Answer 5

Parietal lobe

Contralateral

hemiplegia

facial weakness

hemisensory loss

Eye deviation TOWARDS effected side

Hemianopia

aphasia if in dominant side

Question 6

What is MCA malignant infarct?

Answer 6

Infarction causes so much oedematous swelling that coning occurs. Treatment is by way of decompressive craniectomoy.

Question 7

Possible area and symptoms of PCA stroke

Answer 7

Occipital - visual defecits

Homonymous hemianopia

Question 8

Answer 8

Question 9

What is amaurosis fugax?

Answer 9

Sudden transient loss of vision in one eye

Can be caused by the passsage of an embolus thrugh the retinal artery. Oftern the first clinical sign of a TIA of the ICA - Warning sign of incipient ICA stroke.

Question 10

What is the ACBD score?

Answer 10

Following a TIA

Age >60 1

BP >140 sys or >90 dias 1

Clinical features

Unilateral weakness 2

Speech disturbance 1

Duration of symptoms

<60 2

10-59 1

Diabetes 1

Score <4 is minial risk of stroke

>6 high risk of stroke within 7 days.

Question 11

Absolute contraindications of thrombolysiing?

Answer 11

• Current use of anti-coagulants (possibly within limits but PT time and INR must be checked)
• Use of heparin within 48 hrs
• Platelet count <100
• BP >185 sys or >110 dias

Question 12

What is the MOA of alteplase?

Answer 12

Catalyses the conversion of plasminogen to plasmin (which lyses fibrin).

Question 13

1st line investigation for ?stroke

Answer 13

CT head

to determine if heammorhagis or ischaemic.

May not be sensitive to iscaemia if caugh early, but haemorrhage will show and is therefore contraindication for throbolysis

Question 14

What is the window for thrombolysis?

Answer 14

4 and a half hours

(3 if over 80yo)

Question 15

What is the seconday treatment for ischaemic stroke?

Answer 15

Antiplatelets

aspirin 300mg for 2 weeks, then clopidogrel 75mg

Anticoagulants

Only if indicated by cardio-embolic stroke eg due to AF

Warfarin or NOAC

Question 16

When is it possible to get differing bilateral symptoms from a stroke?

Answer 16

When the lesion is in the midbrain.

The cortical tracts passing through the mid brain will decussate and give contralateral symptoms, but the higher functions from cranial nerves will not decussate. It is therefore possible to have a stroke causing (eg) contralateral hemiparesis and unilateral ptosis.

Question 17

Where is the speech centre wrt right/left hand dominance?

What is the significance?

Answer 17

RHD - 99% in left hemisphere (MCA territory)

LHD - 30% in right hemisphere

In RHD people, a left MCA may cause dysphasia, but a right MCA will not.

In LHD people - dysphasia cannot be used to locaslise the stroke hemisphere