NEURO 202 Stroke

Question 1

What is the most common type of stroke?

Answer 1

Ischaemic stroke

Question 2

What classifications of causes can ischaemic strokes be broken down into?

Answer 2

Thrombotic causes - ruptured mural plaque
Large artery stenosis - acts as an embolic source
Small vessel disease - lacunar infarcts due to disease in small arteries that supply the brain parenchyma
Cardio-embolic : clots from AF and valvular disease
Hypoperfusion : severe hypotension causing infarction in watershed zones

Question 3

What is the most common disease pathology behind lacunar infarcts?

Answer 3

Hypertension

Question 4

What are the clinical features of a Left MCA ischaemic stroke?

Answer 4

R sided weakness: face/arm > leg + dysphasia

Question 5

What are the clinical features of a Right MCA ischaemic stroke?

Answer 5

L sided weakness: face/arm > leg +visual and sensory defect

Question 6

What are the clinical features of a PCA ischaemic stroke?

Answer 6

homonymous hemianopia

other varied defects

Question 7

What are the clinical features of an ischaemic stroke in the internal capsule?

Answer 7

Motor, sensory and sensorimotor loss + dysarthria

NOT dysphasia or other cortical defects

Question 8

What are intracerebral haemmorhages usually due to?

Answer 8

Rupture of micro-aneurysms aka Charcot Bouchard aneurysms

Question 9

What are the signs of a brainstem haemmorhage?

Answer 9

nystagmus, occular palsies, gaze deviates towards the haemmorhage

Question 10

What is a sub-arachnoid hemorrhage and how does it present?

Answer 10

Spontaneous arterial bleeding into the subarachnoid space
Dramatic onset with severe headache, vomiting, coma
Usually due to ruptured berry/sacular aneurysm often at arterial junctions

Question 11

What imaging will show infarction instantly?

Answer 11

Diffusion weighted MRI

Question 12

Why must imaging be done in suspected stroke immediately?

Answer 12

To distinguish between ischaemic and haemmorhagic stroke

Question 13

What makes the patient eligible for thrombolysis?

Answer 13

It is within 3 hours of onset, ischaemic stroke, no recent bleed or surgery, no anti-coag, no signs of improvement

Question 14

What are the long term management options for stroke?

Answer 14

Controlling risk factors: hypertension, diabetes
Anti-platelets for arterial strokes
Anti-coag for cardio-embolic strokes

Question 15

When can carotid endarectomy be done?

Answer 15

If there is >70% narrowing and symptoms

Question 16

What are some of the causes/ risk factors for a venous sinus thrombotic stroke?

Answer 16

Infection spread through sinuses e.g. staph aureus
Trauma
**Pregnancy and OCP use
Hypercoagulable states e.g. antiphospholipid syndrome

Question 17

How does a venous sinus thrombosis present?

Answer 17

Similar to SAH

Question 18

How do you distinguish between a venous sinus thrombosis and a normal ischaemic stroke?

Answer 18

Imagine will show an area of infarct that doesn’t correlated with boundaries of an arterial occlusion

Question 19

What is amarousis fugax due to? When does this symptom occur?

Answer 19

Passage of emboli through the retinal arteries occurs in a TIA