Stroke

Question 1

another name for stroke?

Answer 1

cerebrovascular accident

Question 2

what is a stroke?

Answer 2

Acute onset of focal neurological symptoms/signs lasting >24 hours due to an interruption of blood supply

Question 3

what are the 2 main types of stroke- which is more common?

Answer 3

Ischaemic (85%)= Occur when blood supply in a cerebreal vascular territory is reduced secondary to stenosis or complete occlusion of a cerebral artery

Haemorrhagic (15%)= when there is a rupture of the cerebrospinal artery

Question 4

what are the 3 most common types of iscahemic stroke?

Answer 4

-Large vessel atherosclerosis 50% (e.g. atherosclerotic plaques)
-Lacunar 25% (deep intracranial small vessel atherosclerosis)
-Cardioembolic 20% (e.g. in atrial fibrillation there is stasis of blood flow in the left atrium, predisposing to thrombus formation in the left atrium, and subsequent embolisation to the brain)

Question 5

what are the subtypes of haemorrhagic stroke?

Answer 5

-Primary/intracerebral (can be caused by hypertension, aneurysms)
-SAH causing bleeding on surface of brain

Question 6

strong risk factors for stroke?

Answer 6

-hypertension (biggest risk factor)
-increase in age
-FH of stroke
-smoking
-diabetes mellitus
-afib

Question 7

what scoring is used to assess risk of having a stroke after a TIA and help decide if you want to admit patient?

(risk assessment score)

Answer 7

ABCD2 score
higher score= higher risk of stroke

Question 8

what is the scoring system used for recognising stroke in community?

Answer 8

FAST score

Face
Arms
Speech
Time

Question 9

What artery is involved in TACS (total anterior circulation)

Answer 9

Involves middle cerebral artery and anterior cerebral artery

Question 10

TACS presentation?

Answer 10

Unilateral motor loss involving at least two of face, arms and leg and/or sensory loss

AND

Higher cerebral dysfunction (e.g. dysphagia, neglect)

AND

Homonymous hemianopia

Question 11

what artery is involved in PACS?

Answer 11

Partial occlusion of the anterior circulation
-either ACA or MCA (more sites say MCA but some say either)

Question 12

PACS presentation?

Answer 12

2 out of 3 of TACS presntation:
Unilateral motor loss in at least 2 of arm, face and leg and/or sensory loss

AND/OR

Homonymous hemianopia

AND/OR

Higher cerebral dysfunction

Question 13

what artery is affected in lacunar syndrome/ LACS

Answer 13

small deep penetrating artery that supplies the subcortical parts of the brain (basal ganglia, internal capsule, thalamus and pons)

-supplies brainstem and white matter

Question 14

presentation of LACS/ lacunar syndrome?

Answer 14

There should be NO higher cerebral dysfunction
Should be one of:
-pure sensory stroke
-pure motor stroke
-sensorimotor stroke
-clumsy hand dysarthria (slight weakness and clumsiness of hand with slurred speech)
-ataxic hemiparesis (poor muscle control/ weakness)

Question 15

Vasculature involved in POCS- posterior circulation syndrome?

Answer 15

Involves PCA, basilar, vertebral and cerebellar arteries

Question 16

presentation POCS?

Answer 16

Defined by one of the following:
-Cranial nerve palsy and a contralateral motor/sensory deficit
-Bilateral motor/sensory deficit
-Conjugate eye movement disorder (e.g. horizontal gaze palsy)
-Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
-Isolated homonymous hemianopia

Question 17

what scoring system is used to recognise a stroke in the emergency room?

Answer 17

ROSIER SCORE

score>0 means likely stroke

Question 18

what is the first investigation that should be done if suspected stroke and why?

Answer 18

CT- to distinguish between ischaemic and haemorrhagic

Question 19

how will ischaemic stroke and haemorrhagic stroke present differently on CT?

Answer 19

haemorrhagic- blood looks white
iscahemic- ischaemia looks dark

Question 20

how may an ischaemic stroke present on a diffuse weighted MRI

Answer 20

it may appear very white and bright

Question 21

presentation of cortical events in dominant hemisphere and how do you know if a patients dominant hemisphere is left/right?

Answer 21

Right handed= right hemisphere is dominant
Left handed= left hemisphere is dominant

Dominant hemisphere cortical events often affect language

Question 22

presentation of cortical events in non dominant hemisphere and how do you know if a patients non dominant hemisphere is left/right?

Answer 22

Right handed= right hemisphere is dominant
Left handed= left hemisphere is dominant

Non-dominant hemisphere cortical events affect spatial awareness

Question 23

what type of vessel occlusions benefit most from mechanical thrombectomy?

Answer 23

proximal MCA
internal carotid

Question 24

patient is unable to swallow but needs treatment for ischaemic stroke- how is aspirin given?

Answer 24

PR

Question 25

what is given for long term management after intial treatment of stroke?

Answer 25

clopidogrel
atorvastatin

Question 26

A 68 year old lady presents with right sided arm weakness, right sided facial droop and slurring of speech. On examination of her visual fields, she is found to have a right sided inferior homonymous quadrantanopia.

Which structure is likely to be have been damaged to produce these signs?

Answer 26

Left parietal lobe

PITS
parietal= inferior
temporal= superior

Question 27

occlusion of which artery is associated with ‘locked in syndrome’

locked in syndrome= paralysis of all voluntary muscles except for the ones that control the movements of the eyes

Answer 27

Basilar artery

locked in the basement!