Stroke

Question 1

What is the most common type of stroke?

Answer 1

Ischaemic stroke (85%)

Intracranial haemorrhages (15%)

Question 2

What are the main risk factors for strokes/TIA?

Answer 2

Cardiovascular disease - angina, MI and PVD
Previous stroke or TIA
AF
Carotid artery disease 
HTN
Diabetes
Smoking 
Vasculitis
Thrombophilia
Combined oral contraceptive pill

Question 3

What is criteria for a total anterior circulation stroke (TACS)?

Answer 3

All 3:
Unilateral weakness (and/or sensory loss) of face, arms and legs
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder, decreased level of consciousness)

Question 4

What is the criteria for a partial anterior circulation stroke (PACS)?

Answer 4

2 out of the 3:
Unilateral weakness (and/or sensory loss) of face, arms and legs
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder, decreased level of consciousness)

Question 5

What is the criteria for a posterior circulation syndrome (POCS)?

Answer 5

1 of the following:
Cerebellar or brainstem syndrome
Loss of consciousness
Homonymous hemianopia

Question 6

What is the criteria for lacunar syndrome (LACS)

Answer 6

1 of the following:
Unilateral weakness (and/or sensory deficit) of face, arms and legs, or all three
Pure sensory stroke
Ataxic hemiparesis

Question 7

What is a pontine haemorrhage?

Answer 7

Life-threatening condition that occurs as a complication secondary to chronic hypertension

Presentation:
Reduced GCS
Quadriplegia
Miosis
Absent horizontal eye movements

Question 8

What is the management for stroke?

Answer 8

1st line investigation = CT

Ischaemic stroke:
300mg aspirin stat after CT and continue for 2 weeks
Give thrombolysis (alteplase) after intracranial haemorrhage has been excluded, but must be given within 4.5 hours of onset of symptoms

Haemorrhagic stroke:
Refer for neurosurgery, although most will not be suitable
Management is supportive
Stop anticoagulants (e.g. warfarin) and antiplatelets (e.g. clopidogrel) to minimise further bleeding
Reverse anticoagulant as soon as possible

Question 9

What is the management for TIA?

Answer 9

300mg aspirin stat

If patient has had crescendo TIA or has a suspected cardioembolic source or severe carotid stenosis, may need admission or observation

If patients has had suspected TIA in last 7 days, arrange urgent assessment by specialist stroke doctor within 24hrs

If patient has had suspected TIA that occurred more than a week ago, refer to specialist assessment within 7 days

Question 10

Why should BP not be allowed to be lowered in a stroke?

Answer 10

Risk’s reducing perfusion to the brain