Stroke

Question 1

What are symptoms of a stroke in the carotid territory?

Answer 1

• Weakness of face, arm, leg
• Impaired language

Question 2

What are symptoms of a stroke affecting the posterior circulation?

Answer 2

• Dysarthria
• Dysphagia
• Diplopia
• Ataxia
• Dizziness
• Diplegia

Question 3

What are the 3 common types of stroke?

Answer 3

• Ischaemic
• Primary intracerebral haemorrhage
• Transient ischaemic attack

Question 4

According to the Bamford stroke classification what is the criteria for a total anterior circulation stroke?

Answer 4

3/3 of…
- Unilateral weakness of the face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 5

What is lacunar infarction?

Answer 5

Occlusion of deep penetrating arteries of the brain

Question 6

According to the Bamford stroke classification what is the criteria for a partial anterior circulation stroke?

Answer 6

2/3 of…
- Unilateral weakness of the face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 7

According to the Bamford stroke classification what is the criteria for a lacunar syndrome?

Answer 7

1 of…
- Pure sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic hemiparesis

Question 8

According to the Bamford stroke classification what is the criteria for posterior circulation syndrome?

Answer 8

1 of…
- Cranial nerve palsy and contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Conjugate eye movement disorder
- Cerebellar dysfunction
- Isolated homonymous hemianopia/cortical blindness

Question 9

What is the initial management when someone presents with stroke?

Answer 9

1. ABCDE + bloods + BM
2. Breif Hx + Ex
3. BP
4. NIHSS

Question 10

What is NIHSS?

Answer 10

National institutes of health stroke scale. For grading and tracking the severity of a stroke and monitoring response to acute treatment

Question 11

What is the first line Ix for stroke?

Answer 11

CT head

Question 12

What is the acute management of ischaemic stroke including time-windows?

Answer 12

1. Thrombolysis - within 4.5 hrs of symptom onset
2. +/- Thrombolectomy - within 6 hrs of symptom onset for anterior circulation stroke
3. Or … Aspirin 300mg

Question 13

What is used for thrombolysis in ischaemic stroke?

Answer 13

IV tissue Plasminogen Activator e.g. alteplase 0.9mg/kg

Question 14

What is the purpose of investigations following acute treatment of stroke? Give examples?

Answer 14

To confirm Dx, identify the aetiology and prevent complications
- Bloods - WWC (intracranial infection), platelet count, clotting screen, glucose (hyper/hypoglycaemia can mimic stroke), lipid profile (look for rf)
- ECG - MI, AF, atrial flutter
- Carotid Doppler USS - carotid stenosis
- Echo - endocarditis/thrombosis
- MRI - confirm Dx, look for mini strokes

Question 15

What colour is fresh blood on a CT? What happens over time?

Answer 15

White as is more dense than brain matter, over time darkens as is broken down and becomes less dense

Question 16

What is the management of a primary intracerebral haemorrhage (haemorrhagic stroke)?

Answer 16

1. ABCDE
2. Blood pressure lowering therapy if systolic 150-220 and <6hrs OR if >220 and >6hrs
3. Manage bleeding tendency - reverse meds/treat low platelets
4. Mange underlying malformation - tumour aneurysm, amyloid angiopathy, cavernoma

Question 17

How does amyloid angiopathy cause primary intracerebral haemorrhage?

Answer 17

Amyloid (type of protein) builds up in the walls of cerebral vessels causing them to become friable and rupture

Question 18

How do you reveres warfarin?

Answer 18

Beriplex and vit K

Question 19

How do you reverse LMWH?

Answer 19

Partially reversed with protamine

Question 20

How do you reverse DOACs?

Answer 20

Beriplex may be effective