Stroke

Question 1

Stroke Classification (Oxford Bamford Classification)

Answer 1

Total Anterior Circulation Syndrome (TACS)
Partial Anterior Circulation Syndrome (PACS)
Lacunar Syndrome (LACS)
Posterior Circulations Syndrome (POCS)

Question 2

TACS

Answer 2

Hemiplegia - ≥2 of face, arm and leg.
Homonymous Hemianopia
Cortical signs (dysphasia, neglect etc)

Most severe stroke

Question 3

PACS

Answer 3

2 out of 3 features present in TACS or;
Isolated Cortical dysfunction (dysphsia) or;
Pure motor/sensory signs

Question 4

LACS

Answer 4

Lacunar infarcts are small infarcts in the deeper parts of the brain (basal ganglia, white matter, thalamus).
Occlusion of a single deep penetrating artery.
Affect any 2 of face, arm, leg.

Best prognosis

Question 5

POCS

Answer 5

Cranial nerve palsies
Isolated homonymous hemianopia
Bilateral motor and/or sensory deficits

Question 6

Laterality of Stroke

Answer 6

Dominant - Affects language, reasoning, number skills, written language.

Non-dominant - Creativity, music, spatial orientation

Question 7

TIA

Answer 7

Anterior (carotid) or Posterior (vertebrobasilar) Circulation

Question 8

Anterior Circulaton

Answer 8

(Carotid System)

Amaurosis fugax
Aphasia
Hemiparesis
Hemisensory loss
Hemianopic visual loss

Question 9

Posterior Circulation

Answer 9

(Vertebrobasilar System)

Diplopia
Vertigo
Vomiting
Ataxia
Transient global amnesia
Tetraparesis
Hemisensory loss
Bilateral visual loss

Question 10

ABC2D2 Score

Answer 10

Age - >60 years
BP - >140 or >90 diastolic
Clinical Features - unilateral weakness (2), speech (1)
Duration - >60mins (2), <10 (0)
Diabetes - Yes (1)

<4 - low risk
>6 - high risk for stroke in next 7 days.

Patients with score ≥, or have had 2 recent TIAs should be admitted for investigation and secondary prevention..

Question 11

Anterior Cerebral Artery

Answer 11

Occlusion results in weakness and cortical sensory loss in contralateral lower limb.
Incontinence.

Question 12

Middle Cerebral Artery

Answer 12

Largest branch of carotid artery - branches supply anterior limb of the internal capsule and part of basal nuclei.
Occlusion of insula:
- Contralateral hemiplegia arm and face (leg relatively spared)
- Contralateral hemianopia
- Aphasia (dominant)

Question 13

Basilar Artery

Answer 13

‘Locked in’ syndrome

Question 14

Important Stroke Mimics

Answer 14

7S's
Seizures
Syncope
Sugar (hypoglycaemia)
SOL
Severe migraine
Sepsis (encephalopathy, infection, delirium)
Si-chological

Question 15

Anterior Circulation (arteries)

Answer 15

80% of cerebral flow
MCA
ACA

Question 16

Posterior Circulation (arteries)

Answer 16

20% of cerebral flow
Vertebro-basilar system
Posterior cerebral artery

Question 17

Management of Acute Stroke

Answer 17

Immediate swallow screen
CT brain - confirm diagnosis, infarction, bleed
If not bleed - ischaemic stroke - then give aspirin
Thrombolysis (within 4.5 hours of onset)

Question 18

TIA

Answer 18

All patients need carotid doppler.

Question 19

HAS-BLED

Answer 19

Hypertension
Abnormal Renal and Liver function
Stroke history
Bleeding history
Labile INR
Elderly
Drugs and alcohol use