Stroke

Question 1

Definition of stroke

Answer 1

Persisting neurological complications due to CVS disease

Question 2

Types of stroke

Answer 2

Haemorrhagic- 20%- caused by structural abnormality, hypertension, amyloid antipathy
Ischaemic- 80%- atheroembilic, small vessel, cardioembolic

Question 3

Modifiable risk factore

Answer 3

hypertension, smoking, diabetes, heart disease, pvd, the pill, high cholesterol, increased alcohol use carotid bruits, syphilis

Question 4

signs of stroke

Answer 4

sudden onset of focal neurological signs

Question 5

3 criteria for stroke

Answer 5

1. Unilateral hemiparesis and/or hemisensory loss of the face, arm and leg
2. Homonomous hemianopia
3. Higher cognitive dysfunction eg dysphasia

Question 6

Total anterior circulation infarcts (15%)

Answer 6

Involves middle and anterior cerebral arteries

all 3 criteria are present

Question 7

Partial anterior circulation infarct (25%)

Answer 7

involves small arteries of anterior circulation eg upper or lower division of middle cerebral artery
2 of the criteria are present

Question 8

Posterior circulation infarcts

Answer 8

Involves vertibobasilar arteries
Presents with
cerebellar or brainstem syndromes
loss of consciousness
isolated homonymous hemianopia

Question 9

Lacunar infarcts (25%)

Answer 9

Involves perforating arteries around the internal capsule, basal ganglia and thalamus
presents with 1 of the following
Unilateral weakness (and or sensory decifit) of face and arm, arm and leg or all three
pure sensory stroke
ataxic hemiparesis
Consciousness intact except thalamic stroke

Question 10

Anterior cerebral artery

Answer 10

contralateral hemiparesis and sensory loss

lower extremity> upper

Question 11

Middle cerebral artery

Answer 11

Contralateral hemiparesis and sensory loss, upper extremity> lower
Contralateral homonymous hemianopia
aphasia

Question 12

Posterior cerebral artery

Answer 12

contralateral homonymous hemianopia with macular sparing

visual agnosia

Question 13

webers syndrome (branches of the post. cerebral artery that supply the midbrain)

Answer 13

Ipsilateral CN III palsy. contralateral weakness of upper and lower extremity

Question 14

anterior inferior cerebellar artery (lateral pontine syndrome)

Answer 14

ipsilateral facial weakness and deafness

Question 15

retinal/ ophthalmic artery

Answer 15

amaurosis fugax

Question 16

Basilar artery

Answer 16

locked in syndrome

Question 17

Investigation

Answer 17

Pulse, BP, ECG, BG
Urgent CT/MRI if thrombolysis considered, cerebellar stroke, unusual presentation, high risk of haemorrhage
otherwise- imaging can wait (<24hr)

Question 18

What imagine method is most sensitive for acute infarct

Answer 18

Diffusion weighted MRI but CT helps rule out primary haemorrhage

Question 19

Management

Answer 19

Antiplatelet agents- aspirin 300mg
Thrombolysis- as soon as haemorrhage has been included, as long as onset of symptoms was <4.5hr ago
Thrombectomy

Question 20

Thrombolysis treatment of choice

Answer 20

anteplase

Question 21

Laterality of stroke

Answer 21

left side- dominant side for most people- spoken lang, reasoning, written lang
Right side- creativity, music, spatial awareness
left sided strokes- tend to have a bigger impact

Question 22

things that mimic stroke

Answer 22

seizure, sepsis, SOL, pre syncope, acute confusion, vestibular dysfunction, dementia

Question 23

Rosier score

Answer 23

new onset
Asymmetric facial weakness
asymmetric arm weakness
asymmetric leg weakness
speech disturbance
visual field defect

Question 24

TIA

Answer 24

focal neurological symptoms that occur and leave within 24hr

Not benign- many people have evidence of brain damage on MRI

Question 25

treatment of TIA

Answer 25

aspirin 300mg for 2 weeks then clopidogrel 75mg

Question 26

ABCD2 score

Answer 26

age >60- 2 pts
BP >140/90 1 point
Clinical features- unilateral weakness 2pts
speech disturbance without weakness 1pt
Duration of symptoms
>1hr 2pts
10-59mins 1 pt
Diabetes 1pt

Question 27

what does a score of >4 mean

Answer 27

High risk of an early stroke- must be assessed by specialist within 24hr

Question 28

what does a score of >6 mean

Answer 28

strongly predicts a stroke within 2 days