Stroke

Question 1

What are the 4 types of strokes?

Answer 1

Total anterior circulation
Posterior anterior circulation
lacunar
posterior circulation

Question 2

How do total anterior circulation strokes present?

Answer 2

hemiplegia involving at least two of: face, arm and leg
possible hemisensory loss
homonymous hemianopia

Question 3

What is the prognosis for total anterior circulation strokes

Answer 3

BAD
4% independant at 1 year
39% dead at 30 days
60% dead at a year

Question 4

How do posterior anterior circulation strokes present?

Answer 4

2/3 of: hemiplegia involving at least two of: face, arm and leg
possible hemisensory loss
homonymous hemianopia

OR isolated cortical dysfunction (dysphasia)
OR pure motor/sensory loss

Question 5

What is the prognosis of posterior anterior circulation strokes?

Answer 5

55% independant at one year
4% dead at 30 days
16% dead at 1 year

Question 6

Where do lacunar infarcts happen?

Answer 6

small infarcts in deeper parts of the brain - basal ganglia, thalamus, white matter, brain stem

Question 7

What causes lacunar infarcts?

Answer 7

high BP

high cholesterol

Question 8

What is the presentation of lacunar infarcts?

Answer 8

2/3 of: face, arm or leg affected

Question 9

What is the prognosis of lacunar infarcts?

Answer 9

BEST PROGNOSIS
60% independant at 1 year
2% dead at 30 days
12% dead at 1 year

Question 10

What is the presentation of a posterior circulation stroke?

Answer 10

cranial nerve palsies
bilateral motor or sensory deficits
conjugate eye movement disorders
cortical blindness
cerebellar deficits
locked in syndrom

Question 11

What is the prognosis of posterior circulation strokes?

Answer 11

62% independant at 1 year
7% dead at 30 days
19% dead at 1 year

Question 12

What is the right side of the brain responsible for?

Answer 12

creativity
music
spatial awareness
artistic awareness 
LEFT SIDE OF THE BODY

Question 13

What is the left side of the brain responsible for?

Answer 13

reasoning
spoken language
number skills
written language
RIGHT SIDE OF THE BODY

Question 14

What can occur due to a stroke in the non dominant hemisphere?

Answer 14

neglect syndrome - patient does not acknowledge their hemiparesis or the other side of their body

Question 15

What treatment would you give to a stroke caused by a thrombus?

Answer 15

antiplatelet therapy

Question 16

What treatment would you give to a stoke caused by an embolism?

Answer 16

anticoagulation therapy

Question 17

Where do thrombosis usually come from?

Answer 17

middle cerebral artery

atherosclerotic segment of an artery

Question 18

Where do embolisms usually come from?

Answer 18

atheroma in the internal carotid artery or aortic arch

Question 19

What is the ABCD of medical stroke prevention?

Answer 19

Antithrombotic therapy - antiplatelet and anticoagulants
Blood pressure control
Cholesterol control
Dont smoke
Diabetes

Question 20

For patients with which condition do you work out their CHA2DS2VASC2 score to assess risk of stroke?

Answer 20

atrial fibrillationn

Question 21

What makes up the CHA2DS2VASC2 score?

Answer 21

Congestive HF
Hypertension
Age >/= 75 - 2 
Diabetes Mellitus
Stroke/TIA/Thromboembolism - 2 
Vascular disease
Age 65-74
Sex Catagory - Female

Question 22

What CHA2DS2VASC2 score (out of 9) - would you want to anticoagulate?

Answer 22

2

Question 23

How do you assess bleeding risk before giving warfarin as stroke prophylaxis?

Answer 23

HAS-BLED