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Neurological Core Conditions > Ischaemic Stroke > Flashcards

Ischaemic Stroke Flashcards

1
Q

True or false: The majority of strokes are ischaemic.

A

True

15-20% of strokes are haemorrhagic; 80-85% are ischaemic.

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2
Q

True or false: for a patient to be diagnosed with a stroke, their neurological deficit needs to last at least 24 hours.

A

True

When symptoms persist for less than 24 hours it is categorised as a TIA

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3
Q

What are the common causes of ischaemic stroke?

A

Athrosclerosis

Cardiac embolism (AF, endocarditis, MI)

Chronic hypertension, hypercholesterolaemia, diabetes.

Small vessel occlusion.

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4
Q

Which type of stroke leads to liquefactive necrosis of the brain tissues?

A

Ischaemic stroke

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5
Q

What are the common diagnostic features of ischaemic stroke?

A

Visual deficit
Weakness
Aphasia
Dyspraxia

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6
Q

Infarct of which circulation is being described:

  • Contralateral paresis and sensory loss in the leg
  • Cognitive or personality changes.
A. MCA
B. ACA
C. PCA
D. Lacunar
E. TIA
A

B. ACA

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7
Q

Infarct of which circulation is being described:

  • Variable focal neurological deficits lasting <24 hours (most last < 1 hour)
  • Often without findings on MRI
A. MCA
B. ACA
C. PCA
D. Lacunar
E. TIA
A

E. TIA

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8
Q

Infarct of which circulation is being described:

  • Contralateral paresis and sensory loss in the face and arm
  • Gaze preference toward the side of the lesion.
  • Nondominant hemisphere—neglect.
  • Dominant hemisphere—aphasia.
A. MCA
B. ACA
C. PCA
D. Lacunar
E. TIA
A

A. MCA

CHANGes:

  • Contralateral paresis and sensory loss in the face and arm
  • Hemiparesis
  • Aphasia (dominant)
  • Neglect (nondominant)
  • Gaze preference toward the side of the lesion
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9
Q

Infarct of which circulation is being described:

  • Vertigo
  • Homonymous hemianopia
A. MCA
B. ACA
C. PCA
D. Lacunar
E. TIA
A

C. PCA

The 4 Deadly D’s of Posterior Circulation Strokes:

  • Diplopia
  • Dizziness
  • Dysphagia
  • Dysarthria
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10
Q

Infarct of which circulation is being described:

Symptoms are pure motor, pure sensory, ataxic hemiparesis, or dysarthria.

A. MCA
B. ACA
C. PCA
D. Lacunar
E. TIA
A

D. Lacunar

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11
Q

What does the stroke campaign acronym ‘FAST’ stand for?

A

Facial asymmetry
Arm/leg weakness
Speech difficulty
Time (act fast, call 999)

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12
Q

List some differentials for stroke

A 
Head trauma
Hypo- or hyper- glycaemia
Subdural haemorrhage
Intracranial neoplasm
Migraine
Postictal
CNS lymphoma
Encephalopathy/Encephalitis
Toxoplasmosis
Cerebral abscess
Infected aneurysm
Drug overdose
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13
Q

What investigations would you undertake if you suspected stroke?

A

Emergent CT head without contrast (check for haemorrhage)

MRI

FBC, PTT, Cardiac enzymes, blood glucose

Identify underlying pathology:

  • Cardioembolic (ECG, CXR, echo)
  • Thrombotic (carotid doppler, angiography)
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14
Q

How would you manage an ischaemic stroke (if CT confirms no bleed)?

A

Thrombolysis within 4.5 hours

Endovascular intervention (clot retrieval, shunt)

Antiplatelet

Blood pressure control

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15
Q

True or false: Ischaemic strokes are classified according to the Bamford Stroke Classification.

A

True

Bamford stroke classification is only used for ischaemic stroke; not haemorrhagic.

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16
Q

According to the Bamford Stroke Classification, what are the different classifications of ischaemic stroke? How are these broadly determined?

A

4 types:

  • Total anterior circulation stroke (TACS)
  • Partial anterior circulation stroke (PACS)
  • Lacunar syndrome (LacS)
  • Posterior circulation syndrome (POCS)

Broadly determined by the focal deficits resulting from the CVA/

17
Q

Which arteries are involved in a total anterior circulation stroke (TACS)?

A

Middle and anterior cerebral arteries.

18
Q

Which deficits need to be present to classify a stroke as a total anterior circulation stroke (TACS)?

A

All three of the following:

  • Unilateral weakness (+/- sensory deficit) of the face, arm and leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction (dysphasia, visuospatial disorder)
19
Q

Which arteries are involved in a partial anterior circulation stroke (PACS)?

A

Anterior and middle cerebral arteries, but on part of this circulation has been compromised.

20
Q

Which deficits need to be present to classify a stroke as a partial anterior circulation stroke (PACS)?

A

Two of the following:

  • Unilateral weakness (+/- sensory deficit) of the face, arm and leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction (dysphasia, visuospatial disorder)
21
Q

An ischaemic stroke that affects the brainstem would be classified as which type on the Bamford Stroke Classification?

A

Posterior circulation syndrome (POCS)

22
Q

An ischaemic stroke that affects the cerebellum would be classified as which type on the Bamford Stroke Classification?

A

Posterior circulation syndrome (POCS)

23
Q

Which deficits need to be present to classify a stroke as a posterior circulation syndrome (POCS)?

A

One of the following need to be present for a diagnosis of POCS:

  • Cranial nerve palsy and a contralateral motor/sensory deficit
  • Bilateral motor/sensory deficit
  • Conjugate eye movement disorder (e.g. horizontal gaze palsy)
  • Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
  • Isolated homonymous hemianopia
24
Q

Which deficits need to be present to classify a stroke as Lacunar syndrome (LACS)?

A

One of the following needs to be present for a diagnosis of LACS:

  • Pure sensory stroke
  • Pure motor stroke
  • Sensori-motor stroke
  • Ataxic hemiparesis
25
Q

According to the Bamford Stroke Classification, what is a lacunar syndrome?

A 
Lacunar syndrome (LACS):
- Involves a subcortical ischaemic stroke (small infarcts around basal ganglia, internal capsule, thalamus and pons) that occurs secondary to small vessel disease. There is no loss of higher cerebral functions (e.g. dysphasia).

One of the following needs to be present for a diagnosis of LACS:

  • Pure sensory stroke
  • Pure motor stroke
  • Sensori-motor stroke
  • Ataxic hemiparesis
26
Q

Albert was out for a meal with his Son and Wife when his Son noticed his face had gone droopy on one side and he was struggling to get his words out.

Son had seen FAST adverts so rang 999.

What are the next immediate steps to take when Albert presents in ED?

A

First priorities: brief history and neurological examination. Then CT or MRI with minimal delay.

Neurological Core Conditions (11 decks)

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