stroke

Question 1

what is a thrombotic stroke?

Answer 1

thrombi form within the cerebral arteries

Question 2

what is the main cause of an embolic stroke?

Answer 2

AF- clot forms in heart and dislodges to the brain

Question 3

what is a paradoxical embolic stroke?

Answer 3

rare event- DVT causes stroke
the emboli form the DVT break off and travel from the venous system to the right side of the heart
if the patient has a congenital malformation of their septum- e.g. PFO then the clot can go the the left side and then be pumped to the brain

Question 4

what is a lacunar stroke?

Answer 4

ischaemic stroke typically affecting the basal ganglia

associated wit hypertension

Question 5

what is a hypo perfusion stroke?

Answer 5

• little blood reaching the brain can happen during MI

Question 6

what the diff between stroke and TIA?

Answer 6

• TIA typically lasts less than 24hrs

- there is no infarct with TIA

Question 7

what symptoms do you get when MCA is affected?

Answer 7

• upper limb on contralateral side
• contralateral homonymous hemianopia
• dysphasia if in dominant hemisphere (left for most people) as brooks region is there

Question 8

hat symptoms do yo get with ACA stroke?

Answer 8

affects lower limbs on contralateral side

Question 9

what happens to visual fields if MCA is in non dominant hemisphere?

Answer 9

• contralateral visal neglect
• so can see everything- but vision will be focused on just one side
• because non-dominant hemisphere controls visuospatial attention

Question 10

what is the scoring system used for stroke?

Answer 10

rosiers

• score over 0
• need CT head

Question 11

what are the symptoms of a PCA infarct?

Answer 11

• contralateral homonymous hemianopia with macula sparing (central vision sparing)
• contralateral loss of pain and temp

Question 12

why is there macula spring with PCA infarct?

Answer 12

• bc occipital region is not just supplied by PCA

- MCA also supplies this region

Question 13

which type of stroke presents with cerebellar symptoms and possible quadriplegia?

Answer 13

vertebral basilar infarct

• get cerebellar and brainstem symptoms
• can get locked in syndrome

Question 14

what is given to all stroke px after event?

Answer 14

80 mg atorvastatin 48hrs after event to be taken lifelong

also:
300mg aspirin for 2wks then 75mg clopidogrel lifelong
but if have AF:
- 300mg aspirin 2 wks then give DOAC - if CHADVASC HASBLED allows

Question 15

what is used to differentiate between organic and non organic leg weakness?

Answer 15

hoovers sign

Question 16

what is the barthels index?

Answer 16

predicts disability after a stroke

Question 17

what is the management of stroke presenting <4.hrs?

Answer 17

• thrombolysis with alteplase
  target BP should be <180/110
• can also do thrombectomy if proximal artery problem
• can do thrombectomy up to 24hrs after event

Question 18

wha is the management of stroke >4.5 hrs ?

Answer 18

• 300mg aspirin
• thrombectomy if proximal and less than 24hr
  thrombectomy less than 6hrs is preferable

Question 19

what is the Bamford classification of stroke?

Answer 19

TACS- total anterior cerebral artery stroke
PACS- partial anterior cerebral artery stroke
POCS- posterior circulation syndrome
LACS- lacunar syndrome

Question 20

what is the classification of TACs?

Answer 20

(TACS) involves a large cortical stroke affecting the areas of the brain supplied by both the middle and anterior cerebral arteries.

All three of the following need to be present for a diagnosis of TACS:

1. Unilateral weakness (and/or sensory deficit) of the face, arm and leg
2. Homonymous hemianopia
3. Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 21

what is the classification of PACS?

Answer 21

(PACS) is a less severe form of TACS, in which only part of the anterior circulation has been compromised.

Two of the following need to be present for a diagnosis of PACS:

Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 22

classification of POCS?

Answer 22

A posterior circulation syndrome (POCS) involves damage to the area of the brain supplied by the posterior circulation (e.g. cerebellum and brainstem).

One of the following need to be present for a diagnosis of POCS:

Cranial nerve palsy and a contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movement disorder (e.g. horizontal gaze palsy)
Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia

Question 23

CLASSIFICATION OF LACS?

Answer 23

A lacunar syndrome (LACS) involves a subcortical stroke that occurs secondary to small vessel disease. There is no loss of higher cerebral functions (e.g. dysphasia).

One of the following needs to be present for a diagnosis of LACS:

Pure sensory stroke
Pure motor stroke
Senori-motor stroke
Ataxic hemiparesis