Stroke

Question 1

TIA =

Answer 1

Acute (less than 24 hrs) onset of

Focal neurological signs/symptoms due to

Interruption of blood supply

Question 2

2 subtypes of stroke

Answer 2

Ischaemic - blood clot stops flow of blood to an area of the brain (85%)

Haemorrhagic - weakened/diseased blood vessels rupture (15%)

Question 3

Anterior circulation features of stroke

Answer 3

Anterior cerebral artery/Middle cerebral artery
Hemiparesis
Hemisensory loss
Hemianopia (affects optic tract)
Dysphasia (left MCA)
Sensory/visual inattention/neglect (right MCA)
Lacunar syndromes (perforating arteries)
Pure motor stroke
Pure sensory stroke
Sensorimotor stroke
Clumsy handdysarthria(slight weakness and clumsiness of the hand with slurred speech)
Ataxic hemiparesis (ataxia and usually mild hemiparesis affecting the same side)

Question 4

Posterior circulation features

Answer 4

Supply occipital cortex – hemianopia

Supply brainstem and cerebellum
- Hemiparesis/hemisensory loss (involvement of ascending and descending tracts)
- Ataxia
- Dysarthria
- Due to cranial nerve nuclei involvement – vertigo, diplopia, facial nerve palsy, tongue palsy, dysphagia
(Do get some ‘crossed signs’)

Bilateral symptoms – basilar artery syndrome

Question 5

Classification score to predict stroke outcomes

Answer 5

Modified Rankin score

Question 6

Total anterior circulation syndrome (TACS) =

Answer 6

Hemiplegia involving at least two of face, arm, leg +/- hemisensory loss

Homonymous Hemianopia

Cortical signs (dysphasia, neglect etc)

Question 7

Partial anterior circulation syndrome (PACS) =

Answer 7

Hemiplegia involving at least two of face, arm and leg
+/- hemisensory loss
and Cortical signs (dysphasia, neglect etc);
OR
Isolated Cortical Dysfunction such as dysphasia;
OR
Monoparesis

Question 8

Lacunar syndrome (LACS) =

Answer 8

Lacunar infarcts = small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in the brain stem.

Caused by occlusion of a single deep penetrating artery.

Motor or sensory or both affecting 2 of face, arm and leg.

Question 9

Posterior circulation syndrome (POCS) =

Answer 9

Can include:
- Cranial nerve palsies
- Conjugate eye movement disorders
- Isolated homonymous hemianopia
- Cortical blindness
- Cerebellar deficits +/- motor/sensory signs
- Bilateral signs

Question 10

If unsure, treat with thrombolysis

Answer 10

Thrombolysis is relatively safe for stroke mimics

Question 11

Stroke mimics:

Answer 11

Subdural/extra dural haematoma
Seizure/post ictal signs
Migraine
Space occupying lesion
Metabolic disturbance (glucose!)
Peripheral vestibular issue
Functional neurological disorder

Question 12

Stroke =

Answer 12

Clinical syndrome of vascular origin which lasts longer than 24 hrs OR leads to death

Question 13

What is the ‘ischaemic cascade’?

Answer 13

A series of biochemical reactions that are initiated in the brain and other aerobic tissues after seconds to minutes of ischemia.

• Switch from Aerobic to anaerobic metabolism-
• Accumulation of lactic acid
• Na/K channel dysregulation – cytotoxic oedema
• Na/Ca channel dysregulation –increase Ca within neuron:
  Excitotoxicity
  Degradative enzymes
  Formation of radicals
• Mitochondrial apoptotic factors

Question 14

NIHSS Stroke Scale

Answer 14

Mild = 1-4
Moderate = 5-15
Moderate to Severe = 15-20
Severe = 21-42