Stroke

Question 1

What are the 2 main types of strokes

Answer 1

ischaemic -85%
haemorrhagic-15%

Question 2

What are the subtypes of ischaemic stroke

Answer 2

blockage in blood vessel stops blood flow
-Thrombotic stroke
thrombosis from large vessels

-Embolic stroke
usually a blood clot but can be fat, air, clumps of bacteria

Question 3

What are the risk factors for ischaemic stroke

Answer 3

age
hypertension
smoking
hyperlipidaemia
diabetes mellitus
AF

Question 4

What are the subtypes of haemorrhagic strokes

Answer 4

Intracerebral - bleeding within the brain

Subarachnoid- bleeding on surface of brain

Question 5

What are risk factors of haemorrhagic srokes

Answer 5

age
hypertension
arteriovenous malformation
anticoagulation therapy

Question 6

What are some general symptoms of stroke

Answer 6

motor weakness
speech problems
swallowing problems
visual field defects
balance problems

Question 7

What symptoms may a patient with a cerebral hemisphere infarcts have

Answer 7

contralateral hemiplagia
contralateral sensory loss
homonymous hemianopia
dysphagia

Question 8

What may someone with a brainstem infarction have

Answer 8

more severe symptoms
quadriplegia
lock in syndrome

Question 9

If the lesion is in the ACA- what symptoms may someone have

Answer 9

contralateral hemiparesis and sensory loss

lower extremity > upper

Question 10

If the lesion is in MCA what may someone present with

Answer 10

contralateral hemiparesis and sensory loss

upper extremity > lower extremity

contralateral homonymous hemianopia
aphasia

Question 11

Lesion in PCA- symptoms?

Answer 11

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

Question 12

What is webers syndrome

Answer 12

branches of PCA that supply midbrain

Ipsilateral CNIII palsy
contralateral weakness of upper and lower extremity

Question 13

Lesion to posterior inferior cerebellar artery -
( Wallenberg syndrom )
symptoms?

Answer 13

Ipsilateral - facial pain and temp loss

Contralateral - limb/torso pain and temp loss

Ataxia
Nystagmus

Question 14

Lesion to anterior inferior cerebellar artery

Answer 14

Ipsilateral- facial paralysis and deafness, facial pain and temp loss

Contralateral - limb/torso pain

Question 15

Lesion to retinal/opthalmic artery - symptoms ?

Answer 15

Amaurosis fugax- temporary loss of vision in one eye that returns to normal

Question 16

Lesion to basilar artery- symptoms?

Answer 16

‘Locked-in” syndrome
paralysed except for muscle that control the eys

completely conscious

Question 17

What is the oxford stroke classification

Answer 17

Following criteria should be assessed-
1. unilateral hemiparesis/hemisesnory loss of face arm and leg

2. homonymous hemianopia
3. higher cognitive dysfunction – eg dysphagia

Question 18

What classifies a TACI

Answer 18

total anterior circulation infarct
15% of strokes
involves middle and anterior cerebral arteries
all 3 of oxford stroke classification present

Question 19

What classifies a PACI

Answer 19

partial anterior circulation infarcts
25%
2 of oxford stroke criteria present

Question 20

What classifies a lacunar infarct

Answer 20

25%
involves perforating arteries around internal capsule , thalamus and basal ganglia

presents with 1 of following

-unilateral weakness of face,arm , leg or all three

-pure sensory stroke

-ataxic hemiparesis

Question 21

What classifies a posterior circulation infarct

Answer 21

25%
involves vertebrobasilar arteries

presents with 1 of the followings
- cerebellar or brainstem syndromes
- loss of consciousness
-isolated homonymous hemianopia

Question 22

What symptoms are patients that have suffered from a hemorrhagic stroke more likely to have

Answer 22

decrease in level of consciousness

headache is more common

nausea and vomiting

seizures in up to 1/4 of patients

Question 23

What investigations are required

Answer 23

first line NON - CONTRAST CT HEAD SCAN

Question 24

How do acute ischaemic strokes appear on non-contrast CT head scan

Answer 24

may show areas of low density in grey and white matter of the territory

Hyperdense artery sign - corresponds with responsible arterial clot

Question 25

How do acute hemorrhagic strokes present on non-contrast CT head scan

Answer 25

show areas of hyperdense material surrounded by low density

Question 26

What is stepwise management of iscahemic strokes

Answer 26

ALTEPLASE thrombolysis
if
patient present within 4.5 hours of onset of stroke symptoms

patient has not had previous intracranial haemorrhage, uncontrolled hypertension, pregnant

Then give 300mg aspirin ASAP

antiplatelet therapy continued

THROMBECTOMY if confirmed occlusion of proximal anterior circulation