Stroke

Question 1

What are the 2 classifications of causes of stroke?

Answer 1

Haemorrhage - hypertension/amyloid deposits/structural abnormality etc

Ischemia - cardioembolic/atheroembolic etc

Question 2

Which of the 2 classifications of causes of stroke is more common?

Answer 2

Infarct

Question 3

What heart condition present from birth is a risk factor for an embolic stroke?

Answer 3

• Patent foramen ovale – clots cross from the venous to arterial circulation so DVTs can cause strokes not pulmonary emboli

Question 4

Explain why a patient experiencing a stroke may not be able to smile on the affected side but can raise their eyebrows and close their eyes

Answer 4

The facial nerve supplies the muscles of facial expression and the facial nerve nuclei receive bilateral cortical innervation to the upper part of the face (raising eyebrows and closing eyes) but contralateral cortical innervation to the lower part. Thus, if the face is affected in stroke, the patient may not be able to smile on the affected side, however, the ability to raise his eyebrows and close his eyes are preserved

Question 5

What score is used to determine if a patient is having a stroke?

Answer 5

The Rosier score

Question 6

What colour will haemorrhages vs infarcts show up on a CT?

Answer 6

Haemorrhages will show up white, infarcts will show up slightly darker due to increased water

Question 7

What area of the body aside from the brain must be imaged in the case of an ischemic stroke?

Answer 7

Carotids (carotid doppler)

Question 8

Thrombolysis/thrombectomy can be used in patient presenting within how many hours?

Answer 8

4.5 hours

Question 9

What allied health professional MUST see stroke patients asap?

Answer 9

Speech and language therapists. All patients with stroke are Nil by mouth until assessed by a speech and language therapist

Question 10

What are the common pharmacological treatments after an ischemic stroke?

Answer 10

2 weeks of aspirin + clopidogrel after the 2 weeks for life

Question 11

A pure motor or pure sensory stroke or an ataxic hemiparesis affecting any two of face arm and leg is what kind of stroke?

Answer 11

Lacunar infarct (LACI)

Question 12

A stroke presenting with all 3 of the following is what type of stroke?

• Higher cerebral dysfunction (e.g. dysphasia, visuospatial disturbances, decreased level of consciousness)
• Homonymous visual field defect
• Ipsilateral motor and/or sensory deficit of at least two areas (out of face, arm and leg)

Answer 12

Total anterior circulation infarct (TACI)

Question 13

A stroke presenting with 2/3 of the following is what type of stroke?

• Higher cerebral dysfunction (e.g. dysphasia, visuospatial disturbances, decreased level of consciousness)
• Homonymous visual field defect
• Ipsilateral motor and/or sensory deficit of at least two areas (out of face, arm and leg)

Answer 13

Partial anterior circulation infarct (PACI)

Question 14

A stroke presenting with any of the following is what type of stroke?

• Ipsilateral cranial nerve palsy with contralateral motor and/or sensory deficit
• Bilateral motor and/or sensory deficit
• Cerebellar dysfunction
• Isolated homonymous visual field defect
• Cortical blindness (total or partial loss of vision in a normal-appearing eye)

Answer 14

Posterior circulation infarct (POCI)

Question 15

The headache in a heamorrhagic stroke differs from that of a subarachnoid haemorrhage in what ways?

Answer 15

Not as sudden and severe as SAH and don’t get the secondary meningitis symptoms (photophobia and neck stiffness)