Stroke Flashcards
On what side does ischaemia to the cerebellum cause symptoms?
Ipsilateral side
Where does the PICA supply?
Inferior cerebellum
What is the gold standard investigation for stroke?
Diffusion weighted MRI
What features are caused by an anterior inferior cerebellar artery infarct?
Ipsilateral deafness and facial paralysis
Sudden onset of vertigo and vomiting
What features are caused by a posterior inferior cerebellar artery infarct?
Ipsilateral facial pain and temperature loss
Contralateral limb/torso pain and temperature loss
Ataxia and nystagmus
What are the risk factors for haemorrhagic stroke?
Anticoagulation therapy
Age
Hypertension
Arteriovenous malformation
Drugs that mimic sympathetic nervous system
What are the risk factors for ischaemic stroke?
Age
Hypertension
Smoking
Hyperlipidaemia
Diabetes
Atrial fibrillation
HRT
Oral contraceptive
What symptoms are seen in a total anterior circulation infarct?
Unilateral hemiparesis, or unilateral hemisensory loss of upper or lower limb
Homonymous hemianopia
Higher cognitive dysfunction e.g dyphasia
Which limbs are more typically affected in anterior circulation infarcts?
Lower limbs
Which limbs are more typically affected in middle cerebral artery infarcts?
Upper limbs
What kind of symptoms would be seen with an ophthalmic artery stroke?
Amaurosis fugax
What is the first line investigation for a suspected stroke?
Non-contrast CT head
What is the difference between stroke and Bell’s palsy?
Strokes are forehead sparing, whereas Bell’s palsy involves the forehead
What is the Bamford classification?
A system of classifying and diagnosing ischaemic stroke
What is the Bamford classification of a total anterior circulation infarct?
All three symptoms:
- Homonymous hemianopia
- Unilateral weakness or sensory deficit of the face, arm and leg
- Higher cerebral dysfunction
What is the Bamford classification of a partial anterior circulation infarct?
Two out of three symptoms:
- Homonymous hemianopia
- Unilateral weakness or sensory deficit of the face, arm and leg
- Higher cerebral dysfunction
What is the Bamford classification of a posterior circulation stroke?
One of the following symptoms?
- Cranial nerve palsy and contralateral motor/sensory deficit
- Cerebellar dysfunction
- Bilateral sensory or motor deficit
- Conjugate eye movement disorder
- Isolated homonymous hemianopia
What is the Bamford classification of a lacunar stroke?
One of the following symptoms:
- Pure sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic hemiparesis
What is the initial management of an ischaemic stroke?
300mg aspirin
Thrombolysis if presented within 4.5 hours
Thrombectomy if between 4.5-6 hours
What drug is used in thrombolysis?
Alteplase
What secondary prevention will be given after an ischaemic stroke?
Clopidogrel 75mg daily
Statin
Anti hypertensives
Carotid endarterectomy
What is the second line secondary prevention of ischaemic stroke, if clopidogrel is unsuitable?
Aspirin plus modified release dipyridamole
What is the initial management of a haemorrhagic stroke?
Aim for BP 140/90
Stop anticoagulants and antithrombotics
Reverse any anticoagulation
Refer to neurosurgery
What tools can be used to assess stroke?
FAST
ROSIER
ABCD2
What is a TIA?
A sudden onset of a focal neurological deficit (of vascular origin) that resolves in 24 hours
What are crescendo TIAs?
More than 1 TIA in 7 days
TIAs that are increasing in frequency and severity
What is the definition of a stroke?
Sudden onset of a focal neurological deficit of vascular cause, with symptoms lasting more than 24 hours.
What are the contraindications to thrombolysis?
BP > 180/110
Recent head trauma
GI or intracranial haemorrhage
Recent surgery - 2 weeks
Platelet count
INR > 1.7
What are the symptoms of a basilar artery stroke?
Locked in syndrome
- Complete loss of movement with preserved consciousness and ocular movements
What are the symptoms of an anterior spinal artery stroke?
Loss of pain, temperature and motor function below the level of infarction
What is the management of a TIA?
300mg initial dose of aspirin
75mg aspirin daily for 3 weeks
Clopidogrel long term
Statins
Arrange urgent carotid doppler
What are the symptoms of a basilar artery stroke?
Locked in syndrome
- Where the muscles of the body and face are paralysed but consciousness and eye movements are preserved
What is the second line treatment of TIA if dual antiplatelet therapy is not suitable?
Clopidogrel 300mg loading dose, followed by 75mg clopidogrel OD
Consider giving alongside PPI
