Stroke

Question 1

Which stroke affects the lower limbs more than the upper limbs?

Answer 1

Anterior cerebral artery stroke

Question 2

Which stroke affects the upper limbs more than the lower limbs?

Answer 2

Middle cerebral artery stroke

Question 2

Where does the middle cerebral artery supply?

Answer 2

Most of frontal lobe and lateral parietal lobe

Question 2

Describe signs of a middle cerebral artery stroke

Answer 2

Contralateral hemiparesis or hemiplegia of face and upper extremities more than lower extremities

Broca’s, Wernicke’s or global aphasia

Hemispatial neglect, anosognosia

Question 2

Where does the anterior cerebral artery supply?

Answer 2

Medial and superior parts of frontal lobe and anterior parietal lobe

Question 2

Describe signs of anterior cerebral artery stroke

Answer 2

Contralateral hemiparesis or hemiplegia of lower limbs more so than upper limbs

Apraxia

Anosmia

Question 3

Describe lateral medullary (PICA) syndrome

Answer 3

Contralateral loss of pain and temperature sensation in arms and legs
Ataxia
Nystagmus, N+V
Dysarthria
Horners syndrome

Question 4

Describe lateral pontine (AICA) syndrome

Answer 4

Ipsilateral facial paralysis
Ipsilateral central deafness
Nystagmus, N+V
Ipsilateral limb and gait ataxia
Ipsilateral Horner’s syndrome

Question 5

What is the first line management of stroke

Answer 5

CT head
300mg aspirin after haemorrhage excluded

Question 6

Describe the definitive management of stroke

Answer 6

Thrombolysis with alteplase given within 4.5 hours of symptom onset

Thrombectomy - ASAP within 24 hours hours of symptom onset with IV thrombolysis

Question 7

Describe the management of TIA

Answer 7

Aspirin 300mg
Referral to TIA clinic within 24 hours
Diffusion weighted MRI scan

Question 8

Describe secondary stroke prevention

Answer 8

Clopidogrel 75mg daily

Question 9

Describe Weber’s (posterior cerebral artery) syndrome

Answer 9

Ipsilateral third nerve palsy
Contralateral hemiparesis