Stroke

Question 1

What is a stroke?

Answer 1

A syndrome of sudden onset local or global neurological symptoms caused cerebral tissue infarction

Question 2

2 main causes of stroke?

Answer 2

1. Ischaemic

2. haemorrhage (intracerebral or SAH)

Question 3

Most common type of stroke?

Answer 3

Ischaemic (85% of cases)

Question 4

What is an ischaemic stroke? What are the 3 main causes?

Answer 4

Occlusion of a cerebral blood vessel due to:

1. thrombosis (atherosclerosis)
2. embolic (from AF or carotid artery disease)
3. dissection (intramural haematoma causes compromises cerebral blood flow)

Question 5

Causes of haemorhagic strokes? (3)

Answer 5

1. Hypertension (most common)
2. Trauma
3. brain tumour

Question 6

Risk factors for stroke?

Answer 6

• Essentially these are CV risk factors:
  1. Hypertension
  2. Smoking
  3. Obesity
  4. Diabetes
  5. Hypercholesterolaemia
  6. Carotid artery disease
  7. Sickle Cell
  8. Thrombophillic disorders

Question 7

What are the main blood vessels that supplies the brain?

Answer 7

1. Anterior Cerebral
2. Middle Cerebral
3. Posterior Cerebral

Question 8

What part of the brain is supplied by the ACA?

Answer 8

Part of the frontal lobe and parietal lobe

Question 9

What part of the brain is supplied by the MCA?

Answer 9

Large portion of the lateral hemispheres, internal capsule, basal ganglia

Question 10

What part of the brain is supplied by the PCA?

Answer 10

Occipital and inferior temporal

Question 11

Classification system for ischaemic strokes?

Answer 11

Bramford and Oxford classification

Question 12

How are strokes classified according to Bramford and Oxford classification? (4)

Answer 12

1. TACS
2. PACS
3. LACS
4. POCS

Question 13

Typical clinical features of anterior circulation strokes? (4)

Answer 13

1. facial weakness and sensory deficit
2. limb weakness and sensory deficit
3. higher cerebral dysfunction (dysphagia, visuospatial dysfunction)
4. homonymous hemianopia (same side vision loss)

Question 14

Typical clinical features of posterior circulation strokes?

Answer 14

1. ataxia, dizziness
2. visual field defects
3. diplopia
4. brainstem syndromes
5. dysphagia, dysarthria

Question 15

Types of brainstem syndromes? (2)

Answer 15

1. Wallenburg syndrome (lateral medullary syndrome)

2. ‘Locked in syndrome’

Question 16

Investigations for strokes?

Answer 16

1. bedside - glucose, ECG (AF)
2. bloods - FBC, U&Es, LFTs, bone profile, clotting, lipids, Hba1c
3. CT head - differential between strokes

Question 17

Management of ischaemic strokes?

Answer 17

1. referral to hyperacute stroke unit
2. determine type (CT head)
3. thrombolysis (4.5 hours and NIHSS score between 5 and 26) or aspirin 300mg
4. thrombectomy

Question 18

Management of haemorrhagic strokes?

Answer 18

1. Refer to neurosurgery

2. decompressive craniotomy

Question 19

Medical management in the secondary prevention of strokes?

Answer 19

1. Aspirin 300mg (24-48 hours after thrombolysis) for 2 weeks followed by Clopidogrel 75mg or Warfarin/DOAC in AF
2. Statins (started 48 hours after stroke)

Question 20

Management of patients who are not eligible for thrombolysis?

Answer 20

Aspirin 300mg for 3 weeks

Question 21

Secondary management of strokes?

Answer 21

1. medical management - Aspirin 300mg and Statins
2. Rehabilitation - SALT, PT/OT, dieticians,
3. Driving - stop for 1 month and inform DVLA (more if symptoms not resolved)
4. Carotid artery assessment (doppler and endarterectomy or stenting)

Question 22

What is a TIA?

Answer 22

Transient neurological symptoms due to ischaemia without infarction. Lasts <24 hours.

Question 23

Management of a TIA?

Answer 23

1. Referral to stroke specialist within 24 hours

2. start aspirin 300mg and other secondary prevention measures