Ischaemic stroke Flashcards
Into what 2 groups can ischaemic strokes be further divided?
>24 hours = ischaemic stroke
<24 hours = transient ischaemic attacks
What is the definition of a transient ischaemic attack?
stroke in which the symptoms and signs last less than 24 hours
What proportion of all strokes are ischaemic strokes?
85%
What are 2 subtypes of ischaemic stroke based on the cause?
- Thrombotic: caused by thrombosis from large vessels e.g. carotid
- Embolic: usually blood clot but fat, air or clumps of bacteria may act as embolus
What is an important example of causes of embolic strokes?
AF is important cause of emboli forming in heart
What are 6 risk factors for cardiovascular disease?
- Age
- Hypertension
- Smoking
- Hyperlipidaemia
- Diabetes mellitus
- Atrial fibrillation
What are 5 general symptoms of stroke?
- Motor weakness
- Speech problems (dysphasia)
- Swallowing problems
- Visual field defects (homonymous hemianopia)
- Balance problems
What are 4 symptoms of cerebral hemisphere infarcts?
- Contralateral hemiplegia: initially flaccid then spastic
- Contralateral sensory loss
- Homonymous hemianopia
- Dysphasia
What is meant by lacunar infarcts?
small infarcts around the basal ganglia, internal capsule, thalamus and pons
What are 4 areas which may be the location of lacunar infarcts?
- Basal ganglia
- Internal capsule
- Thalamus
- Pons
What are 4 types of signs that lacunar infarcts may result in?
- Pure motor
- Pure sensory
- Mixed motor and sensory
- Ataxia
What is one of the formal types of classification system for strokes?
Oxford Stroke Classification (aka Bamford Classification) - classifies stroke based on initial symptoms
involves description of territory affected e.g. total anterior circulation infarcts (TACI)
What are 3 examples of types of stroke according to the Oxford Stroke Classification system, that considers initial symptoms?
- Unilateral hemiparesis and/or hemisensory loss of the face, arm and leg
- Homonymous hemianopia
- Higher cognitive dysfunction e.g. dysphasia
What are 4 types of stroke described by the territory affected?
- Total anterior circulation infarcts (TACI) - 15%
- Partial anterior circulation infarcts (PACI) - 25%
- Lacunar infarcts - 25%
- Posterior circulation infarcts (POCI) - 25%
Which 2 arteries are involved in total anterior circulation infarcts?
middle and anterior cerebral arteries
What are the criteria to diagnose a total anterior circulation infarct?
involve middle and anterior cerebral arteries
all 3 of the Oxford Stroke classification criteria are met:
- unilateral hemiparesis and/or hemisensory loss of the face, arm and leg AND
- homonymous hemianopia AND
- higher cognitive dysfunction e.g. dysphasia
What are the criteria to diagnose a partial anterior circulation infarct (PACI)?
involves smaller arteries of anterior circulation rather than middle/anterior cerebral, e.g. upper or lower division of middle cerebral artery. involves anterior OR middle cerebral artery
2 of Oxford Stroke criteria are present (hemiparesis/sensory loss, hemianopia, cognitive dysfunction) OR higher cerebral dysfunction alone
What are the criteria to diagnose a lacunar infarct (LACI)?
involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three (pure motor stroke)
- pure sensory stroke
- sensorimotor stroke
- ataxic hemiparesis
What are 3 types of symptoms, 1 of which must be present to diagnose a lacunar infarct?
- Unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three
- Pure sensory stroke
- Ataxic hemiparesis
What is the difference between hemiparesis and hemiplegia?
hemiparesis is weakness on half of body, hemiplegia is paralysis on half of body
What are the criteria to diagnose a posterior circulation infarct (POCI)? 6 aspects
involves vertebrobasilar arteries and presents with 1 of the following:
- cerebellar or brainstem syndromes
- conjugate eye movement disorder
- bilateral motor/sensory deficit
- ipsilateral cranial nerve palsy with contralateral motor/sensory deficit
- loss of consciousness
- cortical blindness/ isolated homonymous hemianopia
Which arteries are affected in a posterior circulation infarct (POCI)?
vertebrobasilar arteries
What are the 3 criteria, 1 of which the patient must present with, to diagnose posterior circulation infarct (POCI)?
- Cerebellar or brainstem syndromes
- Loss of consciousness
- Isolated homonymous hemianopia
What campaign exists to raise awareness of stroke symptoms?
FAST campaign:
- Face: has it fallen on one side, can they smile
- Arms: can they raise both arms and keep them there
- Speech: is speech slurred
- Time: time to call 999 if see any single one of these signs

