Stroke Flashcards
Define stroke
Clinical syndrome consisting of rapidly developing clinical signs of focal disturbance of cerebral function lasting >24 hrs with no apparent cause other than vascular
Define TIA
Rapidly progressive clinical sings that are focal or global disturbance in cerebral dysfunction lasting less than 24 hrs with no apparent non-vascular cause
Sudden onset, alert and no headache
stroke - headache may occur if hemorrhagic
Lasts 30 mins, resolves and may have a normal MRI
TIA
Stroke classification
80% Ischemic:
a. 60% Atherosclerotic
b. 40% Non-Athero - could be embolic or other
20% Haemorrhagic
a. 85% Intra-cerebral
- Hypertension
- AVM
b. SAH
- aneurysm
- idiopathic
Clinical situations that mimic stroke
- psychogenic
- seizures
- hypoglycaemia
- complicated migraine
- hypertensive encephalopathy
- Wernicke’s
- CNS abscess or tumor
- Drug toxicity
Risk factors in older pts
- Chronic hypertension
- DM
- Smoking
- AF / flutter
- Dyslipidemia
- Lifestyle factors
Risk factors in younger pts
- HIV-related
- TB
- Toxo + Crypto
- Lymphoma
- Vasculopahy
- VZV
- Meningitis - Non-HIV
- rheumatic disease
- mechanical valves
- septic emboli
- ASD
- emboli from LV issue - Other
- meth and cocaine
General risk factors
haemorrhagic
arteriovenous malformations (Berry aneurysms)
dissection: carotid / vertebral artery
- hpt
cerebral abscess: pyogenic, hydatid
- frontal sinusitis
neurocysticercosis
pregnancy-associated
venous sinus thrombosis, PRES
vasculitis
syphilis, SLE, other autoimmune
hypercoagulable states
antiphospholipid syndrome, TTP, Polycythaemia Vera
metastases: breast, bowel, lung, thyroid
Grading of stroke risk
CHA2DS2-VASc
ABCD^2
How to recognise stroke early?
G - gaze in one direction
F - facial droop
A - arms or legs weakness
S - slurred speech or confusion
T - time lost is brain lost
anterior cerebral blood supply
internal carotid – anterior cerebral artery
– middle cerebral artery
posterior cerebral blood supply
vertebrobasilar – posterior cerebral artery
Determine the location of the stroke based on the profile and which branch it affects
- incontinence
- apraxic gait, feet glued to the floor
- face and upper limb spared
Anterior cerebral artery branch of internal carotid
* cortical involvement
* frontal lobe symptoms
Determine the location of the stroke based on the profile and which branch it affects
- greater in upper limb and face
- sensory and motor
- speech may be affected
- constitutional apraxia
- homonymous hemianopia
- lacunar infart
Middle cerebral artery branch if internal carotid
* proximal vs distal
* dominant vs non-dominant hemisphere
* parietal and temporal lobes
How does a lacunar infarct present?
- hemiplegia
- hemisensory loss
Determine the location of the stroke based on the profile and which branch it affects
- cerebellar symptoms
- oculomotor, bulbar and sensorimotor deficit
Posterior that supplies brainstem, cerebellum and occipital lobes
* HIGH MORTALITY
list the cerebellar symptoms of a posterior circulation stroke
V - vertigo
A - ataxia
N - nystagmus
I - intention tremor
S - slurred speech
H - hypotonia
D - dysmetria
D - dysdiadokinesis
T - titubation
Bramford classification of TACS
All three:
1. unilateral weakness of face, arm and leg
2. homonymous hemianopia
3. higher cerebral dysfunction
Bramford classification of PACS
Two:
- unilateral weakness / sensory deficit
- homonymous hemianopia
- higher cerebral dysfunction
LACS criteria
One:
- pure sensory
- pure motor
- mixed
- ataxi hemiparesis
POCS criteria
One:
- cranial nerve palsy and contralateral motor/sensory deficit
- bilateral motor / sensory deficit
- conjugate eye movement
- cerebellar dysfunction
- isolated homonyms hemianopia or cortical blindness
Interpreting NIHSS
< 10 = good prognosis
> 20 = poor prognosis
Stroke investigations
> age & risk factor profile
access to urgent CT scanner / MRI
within lysis/thrombectomy window
infarct vs. haemorrhage on CT / MRI
contraindications to thrombolysis
bedside
urine dipstix & toxicology screen
BP, Hgt, ECG, assess BMI, fundoscopy
blood
FBC, CEU, HIV, TPHA, HbA1c, fasting lipogram
+/- blood culture, autoimmune & hypercoagulable screen
+/- serology for neurocysticercosis, VZV, CLAT etc
Imaging
CT / MRI of brain +/- angiography
CXR; echocardiogram; carotid dopplers
other
+/- lumbar puncture; 24-48 hour Holter monitoring
