Stroke Flashcards
What is the criteria for an anterior circulation stroke (Oxford Stroke Classification)?
Unilateral Hemiparesis +/- Hemisensory loss of face, arm or leg
Homonymous Hemianopia
Higher Cerebellar function (eg. Dysphagia)
Criteria for a lacunar stoke
isolated hemiparesis (Unilateral weakness of the face and arm, arm and leg or all three),
hemisensory loss (pure sensory loss)
OR
hemiparesis with limb ataxia
Criteria for a posterior circulation infarct
One of the following symptoms:
Isolated Homonymous hemianopia
Cerebellar and brainstem syndromes
Loss of consciousness
What is the gold standard investigation for stroke?
Non-contrast head CT
treatment for ischaemia stroke
Thrombolysis
Contraindications for thrombolysis
> 4.5 hours since symptoms onset
previous intracranial haemorrhage, uncontrolled hypertension, pregnancy
If thrombolysis contraindicated, what is the next treatment option for ischaemia stroke?
300mg/day Aspirin
Signs of raised intracranial pressure
Papilloedema
Cushing reflex
Mydriasis (dilated pupil)
Headache
Most common cause of a subarachnoid haemorrhage
Saccular (Berry) aneurysms and Arteriovenous malformations
Presentation of a subarachnoid haemorrhage
Sudden, very severe “thunderclap” headache, often occipital
Neck stiffness and a positive Kernig’s sign
Vomiting
Coma and death
Gold standard investigations of a subarachnoid haemorrhage
Within 6 hours ; non contract head CT
> 6 hours since symptom onset : Lumbar puncture (wait 12 hours to see xanthochromia (yellow in CSF))
Should see normal or raised opening pressure
Treatment of a subarachnoid haemorrhage
Support (oxygen, analgesia, fluids)
Oral Nimodipine (reduce vasospasm)
Definitive: coils by interventional radiologist
What is an epidural haematoma?
A bleed between the dura mater and the skull
Aetiology of an epidural haematoma
Usually low impact traumas to the head that rupture the middle meningeal artery underneath the pterion
clinical presentation of an epidural haematoma
LOC followed by a lucid interval and then LOC again
Lemon shaped/ Leniform haematoma (restricted by suture lines of the skull)
Headache
Possible hemiparesis
Unilateral fixed and dilated pupil
Babinski +
Cushing triad (bradycardia, hypertension and deep/irregular breathing)
Treatment for epidural haematoma
ABCDE
Stop anticoagulants (warfarin)
Treat underlying Coagulopathy conditions
Temporary anticonvulsants (eg. Phenytoin, levetriacetam)
ICP reducing agents (Mannitol, barbiturates)
What is a subdural haematoma?
Bleeding between the dura and arachnoid mater
Aetiology of a subdural haematoma
Head injury (high impact, RTA, falls, sudden changes in speed)
Alcohol abuse
> 65 years old
Blood thinning medications (warfarin)
Violence (shaken baby syndrome)
Clinical presentation of a subdural haematoma
visual defects
facial weakness, limb weakness or sensory disturbance
Ataxia
seizures
Reduced level of consciousness
Head CT finding for subdural haematoma (acute and chronic)
crescent haematoma
Acute: Hyperdense appearance (bright white)
Chronic: hypo dense appearance (black/grey)
Anterior Cerebral Artery lesion features
Contralateral hemiparesis and sensory loss, lower extremity > upper extremities
Middle Cerebral Artery lesion features
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
Posterior cerebral artery lesion features
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Anterior inferior cerebellar artery (lateral pontine syndrome)
Symptoms are similar to Wallenberg’s, but:
Ipsilateral: facial paralysis and deafness
Retinal/ophthalmic artery
Amaurosis fugax
Basilar artery
‘Locked-in’ syndrome
