Stroke

Question 1

Total anterior circulation stroke (TACS)

Answer 1

1. Hemiparesis (contralateral) of >2 of face, arm and leg.
2. Homonymous hemianopia (contralateral)
3. Higher cortical dysfunction (e.g. dysphasia in left cortex)

Question 2

Which arteries may be involved in TACS?

Answer 2

Large infarct in carotid/MCA or ACA territory

Question 3

What is a partial anterior circulation stroke (PACS)?

Answer 3

2/3 of TACS criteria
Usually hemiparesis and higher cortical dysfunction
Deficit is less dense and/or incomplete

Question 4

Which territory usually involved in a posterior circulation stroke (POCS)

Answer 4

Vertebrobasilar

Question 5

What syndromes may be seen in a POCS?

Answer 5

1. Cerebellar syndrome
2. Brainstem syndrome
3. Contralateral homonymous hemianopia

Question 6

Which regions are affected in lacunar strokes?

Answer 6

Basal ganglia, internal capsule, thalamus and pons

Question 7

What are the 5 possible syndromes that can occur with lacunar strokes?

Answer 7

1. Pure motor (post.limb IC; most common)
2. Pure sensory
3. Mixed sensorimotor
4. Dysarthria/clumsy hand
5. Ataxic hemiparesis (ant.limb of IC; weakness and dysmetria)

Question 8

What artery is affected in Wallenburg syndrome?

Answer 8

Posterior inferior cerebellar artery (PICA)

Question 9

What are features of Wallenburg syndrome?

Answer 9

DANVAH
Dysphagia
Ataxia (ipsi)
Nystagmus (ipsi)
Vertigo
Anaesthesia
Horner's sydrome

Question 10

What is locked in syndrome?

Answer 10

When the patient is aware and cognitively intact but is completely paralysed except for eyes

Question 11

What causes locked in syndrome?

Answer 11

1. Ventral pons infarction (basilar artery)

2. Rapid correction of hyponatremia

Question 12

What are some stroke differentials?

Answer 12

Hypoglycemia
Head injury +/- haemorrhage
SOL
Hemiplegic migraine
Todd's palsy
Encephalitis/meningitis
Drugs e.g. opiate overdose

Question 13

Management of acute stroke?

Answer 13

Resuscitate (don’t overhydrate due to risk of cerebral oedema)
Monitor glucose, BP and neurological signs
URGENT CT/MRI
Consider thrombolysis if <4.5hrs since symptom onset (rt-PA)
Aspirin 300mg once haemorrhage excluded
Surgical opinion if haemorrhage

Question 14

Primary prevention of stroke?

Answer 14

Control RFs: HTN, lipids, DM. smoking, cardiac disease
Consider life-long anticoagulation if Afib
Carotid endarterectomy if > 70% stenosis and symptomatic
Increase exercise

Question 15

Secondary prevention of stroke?

Answer 15

Dual antiplatelet therapy
Statin
Warfarin/DOAC if chronic afib
Carotid endarterectomy

Question 16

What is a TIA?

Answer 16

Sudden onset focal neurological deficit lasting <24hrs due to temporary occlusion of part of the cerebral circulation

Question 17

What score is used to determine risk of stroke following TIA?

Answer 17

ABCD2 score

Age > 60
BP > 140/90
Clinical features (hemiparesis =2, speech disturbance)
Duration >1h= 2 points, <1hr = 1point
DM