Stroke

Question 1

Definition of stroke

Answer 1

Rapid onset, neurological deficit > 24 hrs

Question 2

Total anterior circulation stroke

Answer 2

MCA occlusion

All 3 of the following:
Hemiparesis
Homonymous hemianopia
High cerebral dysfunction such as dysphasia

Question 3

Partial anterior circulation stroke

Answer 3

Occlusion of either branch of MCA or ACA

2 of the following:
Hemiparesis
Homonymous hemianopia
High cerebral dysfunction such as dysphasia

Question 4

Lacunar stroke

Answer 4

Causes either pure sensory or motor stroke
No highger cerebral dysfunction or eye signs

Question 5

Posterior circulation stroke

Answer 5

Occlusion in vertebral, basillar or PCA

Signs:
Homonymous hemianopia
Cerebellar syndrome
Cranial nerve syndromes

Question 6

Stroke signs

Answer 6

Muscle wasting on affected side
Pyramidal weakness -> flexed upper limb, extended lower limbs
Spasticity with clap knife features
Reduced power
Hyperreflexia + upgoing plantars
Homonymous hemianopia
Expressive/receptive dysphasia
? AF
Carotid bruits

Question 7

Investigations in Stroke

Answer 7

CBG -> ensure no hypoglycaemia
ECG + 24 hour tape -> ? AF or arrhythmia
CT Head -> ? Haemorrhage
TOE/Bubble echo in young patients
Carotid dopplers
MRI/MR angiogram

Question 8

Management of Stroke

Answer 8

Aspirin 300mg for 14/7
Clopidogrel for life
Statins
Thombolysis if within 4.5 hours
Thombectomy if available within 24 hours
Acute stroke unit -> MDT approach, stroke specialist nurses
Anti-coagulation if AF
Carotid endarterectomy if > 70% but < 100%