Ischaemic stroke

Question 1

What is the essential problem in ischaemic strokes?

Answer 1

Blockage in the blood vessel stops the blood flow

Question 2

What proportion of strokes are ischaemic strokes?

Answer 2

85% of strokes

Question 3

What are the two main subtypes of ischaemic strokes?

Answer 3

1. Thrombotic stroke

2. Embolic stroke

Question 4

What is the definition of a thrombotic stroke?

Answer 4

Thrombosis from large vessels e.g. carotid

Question 5

What is the definition of embolic stroke?

Answer 5

1. a blood clot usually but fat/bacteria may act as an embolus
2. Atrial fibrillation is an important cause of emboli forming in the heart

Question 6

Name 5 general risk factors for ischaemic stroke

Answer 6

1. Age
2. Hypertension
3. Smoking
4. Hyperlipidaemia
5. Diabetes mellitus

Question 7

What is the definition of the Bamford classification?

Answer 7

( also known as the Oxford Stroke Classification )

• classifies ischaemic strokes based on the initial symptoms

Question 8

What is the ‘Bamford classification’? (3)

Answer 8

1. Unilateral hemiparesis and/or hemisensory loss of the face, arm or leg
2. Homonymous hemianopia
3. Cortical dysfunction e.g. Dysphasia

Question 9

Name the features of a ‘Total anterior circulation stroke’?

(TACI) - involves middle and anterior cerebral arteries

Answer 9

1. Hemiparesis +/- hemisensory loss
               (and)
2. Homonymous hemianopia
              (and)
3. Cortical dysfunction

Question 10

Name the features of a ‘Partial anterior circulation stroke’ (PACI)

Answer 10

2/3 below

1. Hemiparesis +/- hemisensory loss
2. Homonymous hemianopia
3. Cortical dysfunction

OR

1. Cortical dysfunction alone

Question 11

What does a ‘Lacunar stroke’ involve?

Answer 11

Involves perforating arteries around the internal capsule, thalamus and basal ganglia

Question 12

What are the features of a ‘Lacunar stroke’?

Answer 12

1. Hemiparesis - unilateral weakness of the body

(OR)

2. Hemisensory loss - pure sensory stroke

(OR)

3. Ataxic Hemiparesis

(no cortical dysfunction or hemianopia )

Question 13

What do ‘Posterior circulation infarcts’ involve?

Answer 13

Involves vertebrobasilar arteries

Question 14

How do POCI present?

Answer 14

Present with one of the following
1. Cerebellar or brainstem syndromes - diplopia / vertigo / ataxia

2. Loss of consciousness
3. Isolated homonymous hemianopia

Question 15

Which subsect of ischaemic strokes have the worst prognosis?

Answer 15

Total anterior circulation stroke - mortality of 60% in a year

Question 16

What is the ischaemic core?

Answer 16

Area of brain tissue local to the blood vessel occlusion whose blood supply is entirely supplied by this vessel, dies.

Question 17

What is the ischaemic penumbra?

Answer 17

1. Surrounding the ischaemic core is an area with some collateral blood supply.
2. This salvageable tissue but without intervention is will also die
3. Goal of hyperacute tx is to save this from becoming part of the ischaemic core.