Stroke Flashcards
What are the categories of stroke in the Oxford community classification?
LACs-Lacunar stroke (small vessel stroke)
PACS- Partical anterior circulation stroke
TACS-Total anterior circulation stroke
POCS- Posterior circulation stroke
What are the criteria for TACs?
TACS must have hemianopia with at least one other of dysphasia or neglect. TACs will also have complete hemipariesis/numbness.
What signs do LACS strokes present with?
Can be motor or sensory or motor and sensory loss in a combination of areas of the body (can’t have leg and face as these are two spread out in the brain)
They may have dysarthria (speech motor problems) or ataxic hemiparesis (weakness more prominent in leg than arm)
Won’t have any higher function problems (e.g. hemianopia)
What signs are seen in a POCS stroke?
Brainstem signs (loss of conciousness, breathing or swallowing problems, paralysis of eye/s) Cerebellar signs- coordination and balance problems
They could have weakness, numbness, hemianopia, dysphasia or neglect.
If dysphasia is a symptom, which side of the brain is likely damaged?
The comprehension of speech is usually controlled by the dominant side of the brain which in the majority of people is the left (particularly if they are right handed)
What side is a stroke likely to be if neglect is seen?
This is usually controlled by the non-dominant side of the brain, so in most people is the right side of the brain.
What does anosagnosia mean?
It is denial of the paralysis/ weakness of one side of their body (hemiplegia)
What does prosopagnosia mean?
It is the failure to recognise faces.
What are common arteries that would cause a TACs?
Carotid or middle cerebral arteries
What are the requirements for a PACS?
2/3 of TACs criteria or one higher cortical deficient (e.g. inattention/neglect or dysphasia) or monoparesis (weakness of one limb)
What is Hoover’s sign?
Positive Hoover’s is when they are weak pushing down but strong pushing down when you lift up the other leg.
What are the investigations used in suspected stroke?
Routine bloods (FBC, glucose, lipids, LFT, ect)
Carotid doppler ultrasound
CT or MRI
ECG
What is the 1st line treatment for ischemic stroke?
Thrombolytic drug such as TPA (tissue plasminogen activator), if given needs to be done as soon as possible and within 4.5 hrs on onset of symptoms.
Thrombectomy is another option.
What are secondary preventative treatments for stroke?
Anti-hypertensives (e.g Beta blockers-propranolol, ACE inhibitors- ramipril)
Anti-platelets
Warfarin
Carotid endarterectomy
