Stroke

Question 1

Define Stroke.

Answer 1

Interruption of the blood supply to a focal part of the brain causing loss of neurological function
Symptoms last >24 hours or lead to death wit no apparent cause other than that of vascular origin

Question 2

What are the stroke types?

Answer 2

Ischaemic 80-85%
Haemorrhagic 15%
Subarachnoid haemorrhage 5%

Question 3

What are the causes of hemorrhagic stroke?

Answer 3

• Hypertension
• Tumour
• Bleeding disorder
• Vascular malformation
• Amyloid angiopathy

Question 4

What are the causes of ischaemic stroke?

Answer 4

• Cardioembolism
• Large vessel artherothrombosis
• Small vessel disease
• Hypoperfusion

Question 5

Where are the watershed areas?

Answer 5

Cortical border zone:
between anterior cerebral artery and middle cerebral artery

Internal border zone:
between lateral cerebral artery and middle cerebral artery

Cortical border zone:
between middle cerebral artery and posterior cerebral artery

Question 6

Describe the brain’s anterior circulation.

Answer 6

• Internal carotids
• Supply:
  Anterior 3/5 of cerebrum
  Diencephalon
• Main branches:
  Middle cerebral artery
  Anterior cerebral artery
  Striate arteries

Question 7

Describe the brain’s posterior circulation.

Answer 7

• Vertebrobasilar arteries

- Supply:
Posterior 2/5 of cerebrum
Diencephalon
Cerebellum
Brainstem

- Main branches:
Posterior cerebral arteries
Striate and thalamus
Pontine
Cerebellar

Question 8

What is the OCSP definition of LACS (lacunar syndrome)?

Answer 8

pure motor, pure sensory, sensorimotor, ataxic hemiparesis

Question 9

What is the OCSP definition of POCS (posterior circulation syndrome)?

Answer 9

brainstem, cerebellar and/or isolated homonymous hemianopia

Question 10

What is the OCSP definition of TACS (total anterior circulation syndrome)?

Answer 10

triad of hemiparesis (or hemisensory loss), dysphagia (or other higher cortical function) and homonymous hemianopia

Question 11

What is the OCSP definition of PACS (partial anterior circulation syndrome)?

Answer 11

2 of the features of TACS or isolated dysphagia or parietal lobe signs (inattention, agnosia, apraxia, alexia)

Question 12

What are some stroke mimics?

Answer 12

Seizures
Sepsis
Syncope
SOL (tumour, subdural)
Somatisation

Question 13

Describe the ABCD2 assessment:

Answer 13

7 points:
Age: [60 or above =1]
Blood pressure: [systolic > 140 and/or diastolic =/> 90 =1]
Clinical features: [unilateral weakness = 2; speech disturbance w/o weakness = 1; other = 0]
Duration of symptoms: in mins [=/> 60 =2; 10-59 =1; < 10 = 0)
Diabetes = 1

2-day strokes scores/risk: 0-3 (1%), 4-5 (4%), 6-7 (8%)