Stroke

Question 1

occlusion of what artery causes a PACS?

Answer 1

middle cerebral artery

Question 2

occlusion of what artery causes a TACS?

Answer 2

anterior and middle cerebral artery

Question 3

occlusion of what artery causes a POCS?

Answer 3

vertebrobasillar arteries

Question 4

occlusion of what artery causes locked in syndrome?

Answer 4

basilar artery

Question 5

occlusion fo what artery is responsible for LACS?

Answer 5

perforating arteries of the internal capsule, thalamus and BASAL GANGLIA

Question 6

what is the criteria for a TACS and PACS?

Answer 6

unilateral hemiparesis +/- hemisensory loss of the face, arm and/or leg
homonymous hemianopia
higher cerebral dysfunction e.g. dysphagia

TACS = 3
PACS = 2/3

Question 7

what is the criteria for a LACS?

Answer 7

unilateral weakness (an/or sensory deficit) of the face and arm, leg and arm or all 3

pure sensory stroke

ataxic hemiparesis

Question 8

what is ataxic hemiparesis and how does it present?

Answer 8

damage to the pyramidal tracts which are responsible for voluntary motor control

• ataxia
• rigidity
• spasticity
• babinski sign positive
• hyperreflexia
• slowing of rapid alternating movements
• weakness

Question 9

what is the criteria for a POCS?

Answer 9

one of the following;

• cerebral or brainstem syndromes
• loss of consciousness
• isolated homonymous hemianopia

Question 10

describe the medical management of stroke

Answer 10

immediate 300mg oral/rectal aspirin
continue for 2 weeks then switch to clopidogrel for lifelong

consider referral for carotid endarectomy or thrombectomy

give statin at least 48hours after stroke if cholesterol > 3.5 (80mg atorvastatin)

maintain fluid balance
IV insulin dextrose infusion if diabetic to maintain glucose 4-11 mmol/L

only lower BP only if indicated - IV Labetalol, Nicarpidine or Clevidipine

Question 11

what classification is used for stroke types?

Answer 11

Oxford classification / Bamford classification

Question 12

what is the criteria for thrombolysis?

Answer 12

symptom onset within 4.5 hours
ischaemic stroke
no contraindications

Question 13

what are the absolute contraindications for thrombolysis?

Answer 13

intracranial neoplasm 
previous stroke, GI haemorrhage or head trauma in past 3 months 
LP in past 7 days 
suspected SAH
seizure at onset of stroke 
pregnancy
active bleeding 
uncontrolled hypertension (> 200/120)
oesophageal varices

Question 14

what are relative contraindications for thrombolysis?

Answer 14

existing anticoagulation - INR > 1.7
susceptibility to bleeding 
active diabetic haemorrhage retinopathy 
suspected intracranial thrombus 
major surgery / trauma in last 2 weeks

Question 15

what is the criteria for thrombectomy?

Answer 15

pre-stroke function status < 3 on modified rankin scale
> 5 on NIHSS scale

onset < 6 hrs with occlusion of proximal anterior circulation

onset 6-12 hrs with occlusion of occlusion of proximal anterior circulation + evidence of potential to salvage brain tissue on CT perfusion/ diffusion weighted MRI

consider if onset < 24 hrs and occlusion of posterior circulation + potential to salvage brain tissue

(NOTE: thrombectomy given with thrombolysis but obviously thrombolysis is given < 4.5 hrs onset)

Question 16

what is the criteria for carotid endarectomy?

Answer 16

age < 80
carotid artery stenosis between 70-99%

may consider it between 50-70% in fit younger patient

Question 17

what scale is used to assess disability?

Answer 17

Barthel index