Stroke

Question 1

Define Stroke

Answer 1

SUDDEN ONSET of neurological symptoms as a result of haemorrhage or ischamia, both leading to infarct

Question 2

What are some common differentials for Stroke?

Answer 2

Migraine - but symptoms will be progressive not sudden
Seizures
Syncope
Brain tumour
Drugs/Alcohol
Hypoglycaemia
Metabolic
Sepsis

Question 3

What are general symptoms of stroke?

Answer 3

Weakness/paralysis on contralateral side
Vertigo/dizziness
Headache
Visual loss
Confusion
Speech problems
Difficulty swallowing
Cognitive problems
Memory problems

Question 4

What are risk factors for stroke?

Answer 4

High blood pressure
Diabetes
High cholesterol
Family history of stroke
Age
Previous stroke or TIA
Smoking/Alcohol
MI
AF

Question 5

What does TACS stand for and what is it?

Answer 5

Total anterior circulation stroke = large cortical stroke (ACA and MCA affected)

3 symptoms required:
Unilateral weakness
Homonymous hemianopia
Higher cortical dysfunction (speech/visuospatial)

Question 6

What does PACS stand for and what’s required for its classification?

Answer 6

Partial anterior circulation stroke = cortical stroke in MCA and/or ACA

2 of the following 3 symptoms needed:
Unilateral weakness
Homonymous hemianopia
Higher cortical dysfunction

Question 7

What is Lacunar syndrome? What type of stroke does it classify?

Answer 7

Small vessel disruption - commonly focal deficits in brainstem-perfusing vessels or lenticulostriate, thalamogeniculate

1 symptom needed:
Unilateral weakness
Pure sensory or pure motor deficit
Ataxic hemiparesis

Question 8

What does POCS stand for and how is it classified?

Answer 8

Posterior circulation stroke = brainstem or cerebellar artery lesion

1 symptom:
Bilateral motor or sensory deficit
Cerebellar/brainstem signs
Isolated homonymous hemianopia
Cranial nerve palsy and contralateral motor/sensory deficit

Question 9

What’s a watershed infarct? Symptoms?

Answer 9

Results from systemic hypotension at the border between cerebral vascular territories (ACA-MCA commonly)

Loss of trunk sensation/motor function and aphasia

Question 10

What are some common signs of lateral medullary syndrome and why?
Lateral medullary syndrome due to ischaemia in lateral medulla

Answer 10

Vomiting, vertigo, nystagmus as a result of vestibular nuclei lesion

Ipsilateral cerebellar signs: ataxia, DDK, dysmetria

Ipsilateral deficits in pain and temp in face and contralateral pain and temp deficit in body due to lateral spinothalamic tract and trigeminal nucleus

Dysphagia, hoarseness, absent gag reflex due to nucleus ambiguus

Ipsilateral horners syndrome (miosis, anhydrosis, ptosis) due to descending sympathetic fibre damage

Question 11

What scales can be used to monitor stroke?

Answer 11

ABCD2 (score >4 = high risk following TIA)

CHADS2 for AF stroke risk

HAS-BLED score for major bleeding risk

ROSIER stroke assessment

Question 12

What’s thrombolytic treatment for stroke?

Answer 12

Alteplase thrombolysis within 4.5 hours once imagining has excluded haemorrhagic stroke

Question 13

What’s an amourosis fugax?

Answer 13

Visual deficit TIA described as curtain falling over the eye

Question 14

What are the diagnoses:

Sudden onset of left sided weakness which progresses, one pain has a severe headache the other has no headache

Answer 14

Headache = intracerebral haemorrhage

No headache = ischaemic stroke

Question 15

What can cause an intracerebral haemorrhage?

Answer 15

Raised blood pressure
Use of Warfarin
Head injury/trauma
Cerebral aneurysm rupture
AVM
Cocaine causing severe hypertension
Bleeding tumours
Bleeding disorders: haemophilia

Question 16

What can cause cerebral ischaemia due to perfusion failure? What does watershed infarction mean?

Answer 16

Severe stenosis of the carotid or basilar artery
Microstenosis of the small deep arteries (lacunar infarction)

Watershed infarction = effects of perfusion failure affect most distal territories before the more proximal

Question 17

How is stroke classified? What are the 4 classifications?

Answer 17

Based on vasculature affected
TACS
PACS
LACS
POCS

Question 18

What are some complications following stroke?

Answer 18

Swallowing -SALT assessment
Fits
Post stroke pain
Contractures
Incontinence
Depression
Reduced cognition
Pressure sores
Infections

Question 19

What’s the secondary prevention for stroke?

Answer 19

Manage complications
Manage BP
Aspirin/Clopidogrel
Statins
Smoking cessation

Question 20

What are TIAs?

Answer 20

Transient ischaemic attacks usually due to drop in perfusion often carotid or vertebrobasilar artery deficiency

Symptoms same as stroke, severe for <30 minutes and make a full recovery within 24 hours

Question 21

What’s the criteria in the ABCD2 scale and when is it used?

Answer 21

Age >60
Bp >140/90 mmHg
Clinical features: unilateral weakness 2 points, speech problems 1 point
Duration of symptoms: >60 mins 2 points, 10-59 mins 1 point
Diabetes 1 point

Score >4 = high risk of stroke
Scale used to predict risk of stroke following TIA

Question 22

Why is AF a risk for stroke? What’s the scale called for this?

Answer 22

When heart beats rapidly and irregularly it may not fully empty itself, meaning blood pools within the heart and can form a clot

CHADVASC