Stroke

Question 1

Symptoms of ACA stroke

Answer 1

Contralateral hemiparesis and sensory loss. Lower limb more effected than upper limb

Question 2

Symptoms of MCA stroke

Answer 2

Contralateral hemiparesis and sensory loss. Upper limb more effected than lower.
Contralateral homonymous hemianopia.
Aphasia.

Question 3

Symptoms of PCA stroke

Answer 3

Contralateral homonymous hemianopia. Visual agnosia.

Question 4

Causes of ischemic stroke

Answer 4

Thrombosis from carotid vessels, embolus e.g. blood clot, air, fat clumps, due to AF.

Question 5

Causes of haemorrhagic stroke

Answer 5

Intracerebral or subarachnoid haemorrhage.

Question 6

Management of ischemic strokes

Answer 6

Offer thrombolysis if < 4.5 hours onset and no bleeding risks.
Once haemorrhage ruled out give aspirin 300mg.
Consider thrombectomy if occlusion in proximal anterior circulation

Question 7

Absolute and relative CI for thrombolysis for stroke:

Answer 7

Absolute- previous IC haemorrhage, seizure at onset, suspected subarachnoid haemorrhage, stroke/brain trauma < 3 months ago, LP <7 days ago, GI haemorrhage < 3 weeks ago, active bleeding, pregnancy, varices, uncontrolled hypertension.

Relative: INR > 1.7, active diabetic haemorrhage retinopathy, suspected intracardiac thrombus, major surgery < 2 weeks ago

Question 8

Secondary stroke prevention

Answer 8

Aspirin + clopidogrel

Question 9

Intracranial venous thrombosis symptoms

Answer 9

Sudden onset headache, nausea and vomiting.

Sagittal sinus thrombosis- seizures, hemiplegia

Cavernous sinus thrombosis- other causes of cavernous sinus syndrome are local infection, neoplasia and trauma. See ophthalmoplegia, 6th nerve palsy, trigeminal nerve involvement, retinal vein thrombosis.