Stroke

Question 1

What is a stroke?

Answer 1

The sudden onset of focal or global neurological symptoms caused by ischaemia or haemorrhage and lasting more than 24 hours

Question 2

What is a transient ischaemic attack?

Answer 2

The term used if the symptoms resolve within 24 hours

Question 3

What is a CVA?

Answer 3

Cerebrovascular accident

Question 4

What are the causes of ischaemic stroke?

Answer 4

Large artery artherosclerosis (carotid)
Small artery occlusion (lacune)
Cardioembolic (AF)
Undetermined/ cryptogenic

Question 5

What are the causes of haemorrhagic strokes?

Answer 5

Primary intracerebral haemorrhage 
Secondary haemorrhage (subarachnoid haemorrhage, arteriovenous malformation)

Question 6

What are the risk factors for stroke?

Answer 6

Previous stroke 
Age 
Male 
Family history 
Hypertension 
Diabetes 
Smoking 
Alcohol 
Obesity 
Inactivity 
Impaired cardiac function 
Oral contraceptives/HRT with high oestrogen content 
Hyper-coagulable states

Question 7

What arteries complete the anterior circulation to the brain?

Answer 7

Anterior cerebral arteries

Middle cerebral arteries (both from ICA)

Question 8

What arteries complete the posterior circulation to the brain?

Answer 8

2 vertebral arteries -> 1 basilar
3 pairs of cerebellar arteries
2 posterior cerebral arteries

Question 9

What is the name of the structure where the arteries in the brain anastomose?

Answer 9

Circle of Willis

Question 10

What are the symptoms of an ACA occlusion?

Answer 10

(Contra-lateral)
Paralysis of foot and leg
Sensory loss over foot and leg
Impairment of gait and stance

Question 11

What are the symptoms of an MCA occlusion?

Answer 11

(Contra-lateral)
Paralysis of face, arm, leg 
Sensory loss of face, arm, leg 
Homonymous hemianopia 
Gaze paralysis to opposite side 
Aphasia if stroke on dominant side

Question 12

What symptoms are present if the stroke involves the right hemisphere of the brain?

Answer 12

Left hemiplegia
Homonymous hemianopia 
Visual agnosia 
Sensory agnosia 
Anosagnosia 
Prosopagnosia

Question 13

What are the symptoms of a PCA occlusion?

Answer 13

Visual fields deficits
Crossed sensori-motor deficits
Hemiparesis, hemisensory loss
Coma, vertigo, nausea, vomiting, cranial nerve palsies, ataxia (brainstem)

Question 14

What are the 4 subtypes of strokes?

Answer 14

Total anterior circulation stroke (TACS)
Partial anterior circulation stroke (PACS)
Lacunar strokes (LACS)
Posterior circulation stroke (POCS)

Question 15

What is TPA?

Answer 15

Tissue plasminogen activator

Question 16

What is the criteria for TPA use?

Answer 16

Less than 4.5 hours from symptom onset
Diasbling neurological deficit
Symptoms present for more than 60 minutes
Consent obtained

Question 17

What is the exclusion criteria for IV TPA use?

Answer 17

Anything that increases the possibility of haemorrhage (blood on CT, recent surgery, recent bleeding episodes, coag problems)
BP > 185 systolic or >110 diastolic
Glucose <2.8 or >22mmol/L

Question 18

What is the aetiology for TIAs?

Answer 18

Atherosclerotic narrowing 
Embolic-cardiac source (AF, recent MI) 
Artery to artery embolism 
Hypercoaguable state 
Arterial dissection 
Venous sinus thrombosis

Question 19

What investigations should be used for stroke?

Answer 19

Routine blood tests 
CT/MRI 
ECG 
Echocardiogram Carotid doppler ultrasound 
Cerebral angiogram 
Hyper-coaguable blood screen

Question 20

What is used in the secondary prevention of strokes?

Answer 20

Anti-hypertensives 
Anti-platelets 
Lipid lowering agents 
Warfarin for AF 
Carotid endarterectomy

Question 21

What are other possible differential diagnosis’ for stroke symptoms?

Answer 21

Hypogylcaemia 
Bell's palsy 
Vestibular disease 
Migraine 
Functional hemiparesis 
Intracranial masses