Neurology - stroke Flashcards
What are the signs and symptoms of anterior cerebral artery occlusion?
- Contralateral hemiplegia
- Gait apraxia
- Severe apathy
- Urinary incontinence
- Lower limb sensory loss
What are the signs and symptoms of middle cerebral artery occlusion?
- Contralateral hemiplegia
- Contralateral homonymous hemianopia
- Contralateral sensory loss
- Dysarthria, dysphasia
What are the signs and symptoms of posterior cerebral artery occlusion?
- Contralateral homonymous hemianopia +/- macular sparing
- Contralateral hemiplegia
- Ataxia/hemiballismus
- Visual agnosia
- Cortical blindness
What are the signs and symptoms of posterior inferior cerebellar artery occlusion?
- Syncope
- Vertigo
- Hemiplegia
- Dysarthria
- Ipsilateral face numbness
- Contralateral limb numbness
What are the signs and symptoms of basilar artery occlusion?
Dizziness
Vertigo
Diplopia
Dysarthria
Facial numbness
Ipsilateral hemiparesis
What are the criteria for a total anterior circulation stroke?
All three must be present
Unilateral weakness +/- sensory deficit of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)
What are the criteria for a partial anterior circulation stroke?
Two of:
* unilateral weakness +/- sensory deficit of the face, arm and leg
* homonymous hemianopia
* higher cerebral dysfunction (dysphasia, visuospatial disorder)
What are the criteria for lacunar syndrome (LACS)?
One of:
* pure sensory stroke
* pure motor stroke
* sensori-motor stroke
* ataxic hemiparesis
What are the criteria for posterior circulation syndrome (POCS)?
One of:
* cranial nerve palsy and a contralateral motor/sensory deficit
* bilateral motor/sensory deficit
* conjugate eye movement disorder e.g., gaze palsy
* cerebellar dysfunction e.g., ataxia, nystagmus, vertigo, dysarthria
* isolated homonymous hemianopia or cortical blindness
What is the difference between a TIA and a stroke?
Symptoms resolve within 24 hours
What is the management of TIA?
Aspirin 300mg immediately
Clopidogrel for stroke prophylaxis
What are the modifiable risk factors for stroke?
Atrial fibrillation (anticoagulated/not anticoagulated)
Smoker/drug use/alcohol
Dietary
Hypertension
Obesity
Hypercholesterolaemia
Oral contraceptive pill
What are the non-modifiable risk factors for stroke?
Ischaemic heart disease
Angina
Family history
Migraine
Diabetes mellitus
Previous stroke/CVA
Hyperthyroidism
What investigations should be performed for stroke?
Bloods: FBC, U&E, LFT, CRP, TFT, coag, lipid
Blood sugar
ECG
Imaging:
* CT head: may be normal, in ischaemic stroke hypodense in the region affected and vessel will be hyperdense
* Angiography
* MRI head
* carotid dopplers and echo if anterior circulation
When is endarterectomy indicated?
Indicated within 2 weeks if carotid stenosis is present and is:
* symptomatic
* 50-90% stenosis
