Stroke Flashcards
A patients presents to a&e with new onset asymmetrical facial weakness and speech disturbance. What is the likely diagnosis and what is his rosier score?
Stroke
Rosier score = 2
What 5 things do you get a point for in the rosier stroke scoring system?
- Asymmetric facial weakness
- Asymmetric arm weakness
- Asymmetric leg weakness
- Speech disturbance
- Visual field defect
What 2 things cause a reduction of 1 point in the rosier score, making a stroke less likely?
- Loss of consciousness of syncope
- Seizure activity
What four things must you know about the stroke before you can make a full diagnosis?
Type
Size
Laterality
Cause
What investigations would you want to perform on a patient with stroke like symptoms?
Urgent CT scan
What are the four different types of strokes?
- Total anterior circulation syndrome
- Partial anterior circulation syndrome
- Lacunar syndrome
- Posterior circulation syndrome
A patient comes into a&e unable to move their left arm or left leg. They also have complete loss of vision in the left visual field slurred speech and their mouth is drooping to the left. What kind of stroke are they most likely to be having?
Total anterior circulation syndrome. This is the most severe type of stroke.
A patient presents with dropping of the right side of their fact and unable to move their right arm. They can walk fine.
Partial anterior circulation syndrome
What is a lacunar infarct?
Small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in the brain stem.
What type of stroke has the best outcome?
Lacunar stroke
Which type of stroke is most likely to present with a cranial nerve palsy?
Posterior circulation syndrome
A patient present with bilateral weakness in their arms. They also have a third nerve palsy. What kind of stroke is most likely?
Posterior circulation syndrome
What type of stroke may present with cortical blindness?
Posterior circulation syndrome
Damage in which hemisphere (right or left) is likely to affect language?
Left.
What would damage to the less dominant right hemisphere cause?
Loss of spatial awareness
What is cerebral amyloid angiopathy?
Cerebral amyloid angiopathy (CAA), also known as congophilic angiopathy, is a form of angiopathy in which amyloid deposits form in the walls of the blood vessels of the central nervous system.
What kind of haemmorhage is cerebral amyloid angipathy most likely to cause?
Lobar
What kind of haemmorhage is high blood pressure most likely to cause?
Deep
How long are CT scan sensitive to blood for?
One week
What type of thrombus is found in a cardioembolic stroke?
Red thrombus
What type of thrombus is found in an atheroembolic stroke?
White thrombus
A man presents with weakness in his left leg. He also appears to be acting strangely. Which artery has most likely been blocked.
Right anterior cerebral.
A women presents unable to move her right arm or leg. Her face is also drooping on the right side and she is unable to speak except for very few words. Which artery has most likely been blocked?
Left middle cerebral
What artery is the largest branch of the internal carotid artery?
Middle cerebral
What lobes do the posterior cerebral arteries supply?
Occipital and Temporal
A man presents with loss of vision in his right visual field with macular sparing. What artery has most likely been occluded?
Posterior cerebral artery
A stroke patient present with ataxia. What kind of stroke is this?
PCOS
A patients on the stroke ward initially presented with isolated homonymous hemianopia. What kind of stroke is this?
PCOS
A patient presents to the stroke unit with left sided weakness of the face arm and leg; homonymous hemianopia and slurred speech. What kind of stroke is this?
Total anterior circulation stroke.
A patient presents to the stroke unit with left sided weakness of the face arm and leg and homonymous hemianopia. His speech is fine. What kind of stroke is this?
Partial anterior circulation stroke.
What major artery in the brain ins not considered to be part of the circle of willis?
Middle cerebral artery
A right handed patient who has had a stroke is struggling to speak. What hemisphere is the stroke likely to have been in?
Left (dominant) hemisphere
A right handed patient who has had a stroke is struggling with spatial awareness. Which hemisphere is most likely to have been affected.
Right. (non dominat)
What kind of stroke are people with atrial fibrillation most at risk of?
Cardio embolic
What kind of stroke are people with a patent foramen ovale most at risk of?
cardio embolic
A 50 year old man presented to the A&E complaining of severe headache and loss of consciousness. Upon further questioning, the patient complains of neck stiffness and mild weakness of the right-side of the body. On examination, the patient is apyrexial and you notice that the patient has a disproportionately long, slender limbs with thin, weak wrists and long fingers and toes.
What is the best investigation of choice to confirm your diagnosis promptly?
CT scan
What structures does the posterior brain circulation supply?
Occipital lobe
Brain stem
Cerebellum
What vessels supplies wernicke and broca’s area?
Middle cerebral artery
What vessel supplies the motor cortex supplying the leg, the frontal lobe and the corpus callosum?
Anterior Cerebral
What artery supplies the part of the motor cortex that supplies the arm and face?
Middle cerebral artery
What is homonymous hemianopia?
Visual field loss on the left or right side of the vertical midline.
A man comes into a &e with a suspected stroke. What imagine modality would you choose first?
CT
What is the best treatment of a patient who has had a stroke 2 hours ago?
Tissue plasminogen activator IV (Thrombolysis)
What medications should patients who have had an ischaemic stroke or TIA be discharged on to reduce the risk of recurrence?
- Low dose aspirin & dipyridamole or clopidogrel
- Statin
- Warfarin (aim for INR 2 - 3
- ACEi and thiazide diuretic
A patient recently had a TIA due to atherosclerosis of the carotid artery. What treatment would be most effective at reducing his risk of a further stroke?
Carotid endarectomy
What does Rivaroxaban inhibit?
Direct factor 10a
What does dabigatran inhibit?
Direct thrombin inhibitor
