Stroke Flashcards
What is posterior circulation syndrome?
POCS
cranial nerve palsy + contralateral motor/sensory deficit OR bilateral stroke OR disorders of conjugate eye movement OR isolated cerebellar stroke OR isolated homonymous hemianopia
What is lacunar syndrome?
LACS
pure motor or pure sensory deficit affecting two or three out of face, arm and leg or acute-onset movement disorder
what is total anterior circulation syndrome?
TACS
1 - higher cortical dysfunction
(dysphasia/dyscalculia/dyspraxia/ neglect)
+
2 - homonymous visual field defect
+
3 - motor and/or sensory deficit contralateral to the lesion of at least two areas out of face, arm, and leg
What is partial anterior circulation syndrome?
PACS
two or three of TACS symptoms or isolated higher cortical dysfunction
what are the RFs for an embolic stroke?
smoking
adverse FH
diabetes
HTN
- -> internal carotid artery artheroma
- -> athermatous plaque in ascending aorta
what are the RFs for an ‘in-situ’ thrombosis?
atheroma RF polycythaemia or hyperviscosity vasculitis e.g. SLE high alcohol intake thrombophilia e.g. factor V leiden OC pill
what are the RFs for an intra-cranial bleed?
Hypertension-dominant risk factor
anticoagulation
thrombolysis
What investigations would you carry out in a suspected stroke?
Bloods - FBC, U&Es, lipids, glucose, ESR, TFT, clotting screen
CT head - establish diagnosis
MRI brain
- diffusion weighted image sequences to confirm infarcts
- magnetic resonance angiography (MRA) to look for intracranial stenosis
ECG - AF. LVH, cardiac ischaemia
Carotid Doppler - look for ipsilateral carotid stenosis
Echo - to exclude endocarditis or mural thrombus
What are the indications for urgent neuroimaging (<1 hour)?
Being considered for acute stroke thrombolysis
On anticoagulant therapy Any known bleeding diathesis
Depressed Glasgow Coma Scale
Unexplained fluctuating or progressive symptoms
Papilloedema or neck stiffness
Severe headache at onset of stroke symptoms
What is the definition of a stroke?
clinical syndrome of focal neurological deficit of presumed vascular origin that develops suddenly and lasts for MORE THAN 24 hours or leads to death
What is a TIA?
clinical syndrome of acute loss or ocular function lasting for less than 24 hours
how common are strokes?
third most common cause of death in developed countries
25% of strokes occur in patients under 65
What is the hyperacute management in a stoke?
FAST or ROSIER screening
Admission to stoke unit
Neuroimaging - CT for any patient meeting criteria and within 24 hr for anyone who has had a stroke
Thrombolysis - for patients with ischaemic stroke presenting within 4.5 hr of onset
Clopidogrel should be given as soon as possible in acute ischaemic stroke
Patients with primary intracerebral haemorrhage who are taking warfarin/heparin should have this reversed
What is the acute management of stroke?
monitor to detect any disturbances of homeostasis
supplemental oxygen should be administered to hypoxic patients
blood glucose conc should be maintained at 4-11mmol/L
swallowing assessment should be performed as soon as possible
referral to vascular surgery if carotid Doppler if stenosis on carotid Doppler >50% for consideration of carotid endarterectomy
What is the surgical management in acute stroke?
decompressive hemicrainectomy in MCA syndrome
surgical evacuation or cerebrospinal fluid shunt insertion may be considered in patients with primary intraceraral haemorrhage who develop hydrocephalus
shunt closure in patients with atrial spetal defect
