Stroke Flashcards
Stroke
sudden onset of focal neurological deficit of presumed vascular aetiology lasting >24 hours
Also referred to as cerebrovascular accident CVA
changes on CT
TIA
same except < 24 hours (90% last < 2 hours)
transient neurological dysfunction secondary to ischaemia without infarction
Caused by sudden reduction in blood supply to brain
No changes on CT
crescendo TIA
two or more TIAs within a week
high risk of developing in to a stroke
Cerebrovascular accidents are either:
Ischaemic (87%)
Intracranial haemorrhage (13%)
Stroke/TIA RF
Smoking
Alcohol misuse and drug abuse (for example cocaine, methamphetamine)
Physical inactivity
Poor diet
HTN
AF
IE
Vascular disease
Congestive HF
MI Hx
Migraine
Sickle cell
Haemophilia
CKD
Connective tissue disease
PCKD
OSA
Anticoagulation ( haemorrhagic stroke)
Ischaemic stroke RF in young people
carotid/ vertebral Dissection
Cardioembolism eg PFO, endocarditis
Vasculitis
antiphospholipid syndrome
inherited thrombophilia
Genetic eg CADASIL, Fabrys, MELAS
Aetiology intracranial haemorrhage
HTN
Cerebral amyloid angiopathy
Tumours,
AVMs
aneurysms
Oral anticoagulants
Stroke history taking
Onset
Seizure or hypoglycaemia
Vision
Weakness of face/limbs
Speech
which hand is dominant
Do they drive
Context/risk factors/comorbidity
Oxford/bamford main criteria points
- Hemiparesis (weakness on one side) and/or hemisensory loss of the face, arm & leg
- contralateral homonymous hemianopia (person sees only one side )
- higher cognitive dysfunction e.g. dysphasia, visuospatial disorder
TACI (total anterior circulatory infarct)
15%
involves middle and anterior cerebral arteries
All 3 criteria
PACI (partial anterior circulatory infarct)
25%
Any 2 of the above or isolated cortical dysfunction
involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
A PACI involves the anterior OR middle cerebral artery on the affected side
Anterior cerebral artery
legs, behaviour
Middle cerebral artery
arms, speech
LACI (lacunar circulatory infarct)
25%
involves small deep perforating arteries around the internal capsule, thalamus and basal ganglia
no complex features, presents with 1 of the following:
- 1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
- 2. pure sensory stroke.
- 3. ataxic hemiparesis
strong association with hypertension
POCI (posterior circulatory infarct)
25%
involves damage to the area of the brain supplied by the posterior circulation (e.g. cerebellum and brainstem).
involves vertebrobasilar arteries
presents with 1 of the following:
- 1. cerebellar or brainstem syndromes
- 2. loss of consciousness
- 3. isolated homonymous hemianopia
Symptoms like: Vertigo, diplopia,ipsilateral ataxia and nystagmus from cerebellar damage
Posterior cerebral artery
vision, ataxia
Basilar artery occlusion
locked in quadriparesis with preserved consciousness and ocular movements), loss of consciousness, or sudden death
lateral pontine syndrome
Anterior inferior cerebellar artery
condition similar to the lateral medullary syndrome but with additional involvement of pontine cranial nerve nuclei eg deafness,facial paralysis
What is Wallenberg’s sydnrome/lateral medullary syndrome
caused by occlusion of the posterior inferior cerebellar artery leading to infarction of the lateral medulla.
Clinical presentation of Wallenberg’s sydnrome
DANVAH
Dysphagia, ipsilateral Ataxia, ipsilateral Nystagmus, Vertigo, Anaesthesia(Ipsilateral facial numbness and contralateral pain loss on the body) and ipsilateral Horner’s syndrome
What is Weber’s syndrome
Caused by lesions to the Medial midbrain/cerebral peduncle.
(paramedian branches of the upper basilar and proximal posterior cerebral arteries)
Clinical presentation of webers syndrome
ipsilateral oculomotor CN III palsy and contralateral hemiparesis (motor)
Clinical presentation TIA
focal neurological deficit (such as speech difficulty or arm/leg weakness/sensory changes).
most symptoms resolve within 1 hour
absence of positive symptoms suggestive of differentials (e.g. shaking preceding the weakness, suggestive of a focal motor seizure)
absence of headache, which would suggest a differential e.g. migraine or intracranial bleeding.
Investigations
CT
FBC / PV or ESR
U&Es, lipids, glucose, ESR, TFTs, clotting and vasculitis screen
Glucose / cholesterol / renal function
ECG eg af,mi
Carotid ultrasound can be used to assess for carotid stenosis
24 hour ecg tape for paroxysmal af
ECHO for infected heart valves, endocarditis,PFO and septal defects
vasculitis eg ANA
thrombophilia screen
