Stroke

Question 1

What is the definition of a stroke?

Answer 1

sudden onset focal neurological deficit of vascular aetiology with symptoms lasting less that 24 hours

Question 2

When does an ischaemic stroke occur?

Answer 2

when blood supply in a cerebral vascular territory is reduced due to stenosis or occlusion of a cerebral artery

Question 3

what is the leading reason for ischaemic stroke

Answer 3

large vessel atherosclerosis e.g. in the carotid artery

Question 4

What are the main risk factors for stroke?

Answer 4

1. age
2. male sex
3. Fam hx of ischaemic stroke
4. atrial fibrillation

Question 5

What is a total anterior circulation infarct defined as?

Answer 5

1. total hemiplegia or hemiparesis
2. contralateral homonymous hemianopia
3. higher cerebral dysfunction

it involves the anterior and middle cerebral arteries on the affected side

Question 6

What is a partial anterior circulation infarct defined as?

Answer 6

2 of the TACI or
higher cerebral dysfunction alone

it involves the anterior or middle cerebral artery on affected side

Question 7

What is a lacunar infarct?

Answer 7

pure motor stroke/ pure sensory stroke/ sensoriomotor stroke

Question 8

What is there none of in a lacunar infarct?

Answer 8

visual field defect
higher cerebral dysfunction
brainstem dysfunction

Question 9

Which part of the brain does a lacunar infarct affect?

Answer 9

small deep perforating arteries
internal capsule
thalamus

Question 10

What are the 5 criteria for a posterior circulation infarct?

Answer 10

cerebellar dysfunction

conjugate eye movement disorder

bilateral motor/sensory deficit

ipsilateral cranial nerve palsy

cortical blindness or isolated hemianopia

Question 11

Which artery is usually occluded so as to cause locked in syndrome?

Answer 11

basilar artery

Question 12

What is Wellenberg’s syndrome?

infarct to posterior inferior cerebellar artery

Answer 12

lateral medullary syndrome which presents as:

1. ipsilateral horner’s syndrome
2. ipsilateral loss of pain and temperature sensation to the face
3. contralateral loss of pain and temperature sense to the body

Question 13

What is Weber’s syndrome?

Answer 13

medial midbrain syndrome
ipsilateral CN3 palsy
contralateral hemiparesis

Question 14

Acute management of ischaemic stroke

Answer 14

1. CT head on arrival to distinguish if ischaemic or haemorrhagic
2. MRI to confirm ischaemic
3. Alteplase given if not having intracranial haem
4. thrombectomy in 6 hours of onset for ACI and 12 hours for PCI
5. aspirin 300mg daily for 2 weeks

Question 15

What is the strongest risk factor for haemorrhagic stroke?

Answer 15

cocaine use - tested by serum toxicology screen

Question 16

Long term stroke management

Answer 16

1. control hypertension - initiate medication 2 weeks post stroke
2. clopidogrel 75mg once daily or if secondary to AF, give warfarin 2 weeks post stroke
3. atorvastatin
4. smoking cessation
5. diabetes screening
6. carotid endarterectomy

Question 17

pathophysiology of cardio-embolic strokes

Answer 17

atrial fibrillation causes stasis of blood flow in left atrium
thrombus formation in left atrium
embolisation to the brain

Question 18

what percentage of strokes are haemorrhagic?

Answer 18

15%

Question 19

pathophysiology of haemorrhagic stroke

Answer 19

weakening of cerebral vessels
cerebral rupture
haematoma formation

Question 20

acute management of haemorrhagic stroke

Answer 20

decompressive hemicraniectomy

aim to keep blood pressure <140/80

Question 21

Wallenberg “DANVAH”

Answer 21

Dysphagia
ipsilateral Ataxia
Nystagmus
Vertigo
Anasthesia (ips facial numbness and contralateral pain loss on the body) 
Horner's syndrome