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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

Which vessel(s) can be occluded in an anterior circulation stroke?

A
  • Internal carotid artery
  • Middle cerebral artery
  • Anterior cerebral artery
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2
Q

What is the criteria for a total anterior circulation stroke?

A
  1. Motor or sensory deficits (contralateral) in 2 out of 3 of the face, arm, and legs
  2. Impaired higher function, apraxia, agnosia, hemispatial neglect, altered consciousness
  3. Visual field changes, esp homonymous hemianopia
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3
Q

What is the criteria for a partial anterior circulation stroke?

A

2 out of 3 of:

  1. Motor or sensory deficits (contralateral) in 2 out of 3 of the face, arm, and legs
  2. Impaired higher function, apraxia, agnosia, hemispatial neglect, altered consciousness
  3. Visual field changes, esp homonymous hemianopia
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4
Q

Which vessel(s) can be occluded in a posterior circulation stroke?

A

Vertebral-basilar system or posterior cerebral artery

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5
Q

What are the features of a posterior circulation stroke, generally?

A
  • CNS palsy plus contralateral motor/sensory deficits of the body
  • Eye movement problems
  • Isolated homonymous hemianopia
  • Cerebellar lesions
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6
Q

What are the features of an anterior cerebral artery stroke?

A
  • Contralateral hemiparesis and sensory loss

- Lower extremity more severely affected than upper extremity

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7
Q

What are the features of an middle cerebral artery stroke?

A
  • Contralateral hemiparesis and sensory loss
  • Upper extremity more severely affected than lower extremity
  • Contralateral homonymous hemianopia
  • Aphasia
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8
Q

What are the features of an posterior cerebral artery stroke?

A
  • Contralateral homonymous hemianopia with macular sparing

- Visual agnosia

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9
Q

Which vessel is occluded in locked-in-syndrome?

A

Basilar artery

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10
Q

What are the features of locked-in-syndrome?

A

Complete paralysis of voluntary muscles in all parts of the body
Eye muscles and sometimes the big toe may be spared

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11
Q

Which vessel is occluded in lateral medullary syndrome/Wallenberg syndrome?

A

Posterior inferior cerebellar artery

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12
Q

What are the features of lateral medullary syndrome/Wallenberg syndrome?

A
  • Cerebellar features (ataxia, nystagmus)
  • Ipsilateral face signs (Horner’s, loss of temperature and pain sensation, dysarthria, dysphagia
  • Contralateral body signs (loss of temperature and pain sensation)
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13
Q

Which vessel is occluded in median medullary syndrome/Dejerine syndrome?

A

Paramedian branches of the anterior spinal artery

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14
Q

What are the features of medial medullary syndrome/Dejerine syndrome?

A
  • Contralateral paralysis of the upper and lower limb
  • Contralateral decrease in proprioception, vibration, and/or fine touch sensation
  • Ipsilateral deviation of the tongue
  • Dysphagia
  • May present with vertigo, nausea, and contralateral limb ataxia
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15
Q

Which vessel is occluded in lateral pontine syndrome/Marie-Foix syndrome?

A

Anterior inferior cerebellar artery

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16
Q

What are the features of lateral pontine syndrome/Marie-Foix syndrome?

A
  • Ipsilateral limb ataxia
  • Ipsilateral loss of pain and temperature sensation of the face
  • Ipsilateral facial weakness
  • Ipsilateral hearing loss, vertigo, and nystagmus
  • Contralateral hemiplegia/hemiparesis
  • Contralateral loss of pain and temperature sensation
17
Q

Which vessel is occluded in medial inferior pontine syndrome/Foville syndrome?

A

Paramedian branches of the basilar artery

18
Q

What are the features of medial inferior pontine syndrome/Foville syndrome?

A
  • Gaze palsy to the side of the lesion
  • Ipsilateral abducens and facial nerve palsy
  • Contralateral hemiplegia
19
Q

Which vessel is occluded in midbrain/Weber’s syndrome?

A

Branches of the posterior cerebral artery

20
Q

What are the features of midbrain/Weber’s syndrome?

A
  • Ipsilateral surgical CN III palsy (diplopia, ptosis, RAPD)
  • Contralateral hemiplegia/hemiparesis
  • Contralateral parkinsonian rigidity
21
Q

Which vessel(s) is occluded in lacunar stroke?

A
  • Lenticulostriate
  • Thalamoperforating
  • Pontine perforating
22
Q

What are the features of lacunar stroke?

A
  • Unilateral motor and/or sensory deficits
  • Ataxic hemiparesis: ipsilateral clumsiness ans weakness, as opposed to cerebellar dysfunction
  • Dysarthria and clumsy hand
23
Q

What is first-line imaging in a suspected stroke?

A

Non-contrast CT head

24
Q

What is the ROSIER score?

A

ROSIER = Risk Of Stroke In the Emergency Room

  • Score >0 means that a stroke is likely
  • LOC or syncope: -1 point
  • Seizure activity: -1 point
  • Acute asymmetric facial weakness: +1 point
  • Acute asymmetric arm weakness: +1 point
  • Acute asymmetric leg weakness: +1 point
  • Speech disturbance: +1 point
  • Visual field defect: +1 point
25
Q

Describe the management of TIA.

A
  • 300mg aspirin immediately
  • Urgent (24h) assessment in outpatient TIA clinic if TIA was in last 7 days
  • Assessment within 7 days at outpatient TIA clinic if TIA >7 days ago
  • Antithrombotic therapy: clopidogrel/aspirin + dipyridamole
26
Q

In which situations would you NOT give aspirin immediate for TIA?

A
  • Patient has bleeding disorder
  • Patient taking anticoagulation
  • Patient already on low-dose aspirin
  • Aspirin contraindicated
27
Q

Describe the management of acute stroke.

A
  1. Thrombolysis:
    - Alteplase
    - Give up to 4.5h of onset of symptoms
  2. Antiplatelet drugs:
    - Aspirin (300mg loading dose, then 75mg daily)
  3. Anticoagulation:
    - Immediate treatment with heparin reduces DVT and PE
  4. Thrombectomy
  • Admission to stroke unit
  • O2 therapy
  • Control of BP
  • Control blood glucose
28
Q

When should thrombectomy be done and who should it be offered to?

A
  • Offer thrombectomy ASAP and within 6h of symptom onset with thrombolysis to people who have acute ischaemic stroke AND confirmed occlusion of the proximal anterior circulation
  • Offer thrombectomy ASAP to people who were last known to be well between 6-24h previously and have confirmed occlusion of the proximal anterior circulation IF there is potential to salvage brain tissue (indicated by a limited infarction core of DW MRI)
29
Q

What is the secondary prevention measures after a stroke?

A
  • Clopidogrel 75mg

- Aspirin + MR dipyridamole in people for whom clopidogrel is not tolerated or contraindicated

30
Q

What are the absolute contraindications for thrombolysis?

A
  • Previous intracranial haemorrhage
  • Seizure at onset of stroke
  • Intracranial neoplasm
  • Suspected SAH
  • Stroke or TBI in preceding 3 months
  • LP in preceding 7 days
  • GI bleed in preceding 3 weeks
  • Active bleeding
  • Pregnancy
  • Oesophageal varices
  • Uncontrolled HTN >200/120

Neurology (46 decks)

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