Stroke Flashcards
Anterior cerebral artery stroke symptoms:
- contralateral hemiparesis and sensory loss
- lower extremity>upper
Middle cerebral artery stroke symptoms:
- contralateral hemiparesis and sensory loss
- upper>lower
- contralateral homonymous hemianopia
- aphasia
Posterior cerebral artery stroke symptoms:
- contralateral homonymous hemianopia with macular sparing
- visual agnosia
Weber’s syndrome:
- branches of posterior cerebral after that supply the midbrain
- ipsilateral CNIII palsy
- contralateral weakness of upper and lower extremity
Posterior inferior cerebellar artery stroke:
- lateral medullary syndrome
- Wallenberg syndrome
- ipsilateral facial pain and temp loss
- contralateral: limb/torso pain and temperature loss
- ataxia, nystagmus
Anterior inferior cerebellar artery stroke:
- lateral pontine syndrome
- symptoms similar to Wallenberg’s
- ipsilateral: facial paralysis and deafness
Retinal/ophthalmic artery stroke:
amaurosis fugax
Basilar artery stroke:
locked in syndrome
What is a lacunar strore:
- either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
- strong association with HTN
- common sites include the basal ganglia, thalamus and internal capsule
Ischaemic strokes:
- 85%
- thrombotic strokes
- embolic strokes: fat, air or bacteria, atrial fibrillation important cause
- RF: age, HTN, smoking, hyperlipidaemia, diabetes mellitus
Haemorrhagic strokes:
- 15%
- intracerebral haemorrhage
- subarachnoid haemorrhage
- RF: age, HTN, arteriovenous malformation, anticoagulant therapy
Assessment and investigation of strokes:
- FAST (78% predictive value)
- ROSIER >1 = stroke likely
- non contrast CT
Fluid management post-stroke:
- hypovolaemia can worsen ischaemic penumbra and increase risk of complications
- oral hydration preferable if safely able to swllow
- IV hydration otherwise - isotonic saline without dextrose
Glycaemic control post-stroke:
- post-stroke, hyperglycaemia increases mortality
- keep level between 4-11mmol/L
Blood pressure management post-stroke:
- anti-hypertensives only post ischaemic stroke if hypertensive emergency or: hypertensive encephalopathy, hypertensive nephropathy, hypertensive cardiac failure/MI, aortic dissection, pre-eclampsia/eclampsia
- lowering BP can compromise collateral blood flow to affected region
- lower BP by 15% in first 24 hours
- labetalol, nicardipine and clevidipine
- if candidates for thrombolytic therapy: bP reduced to 185/55mmHg or lower
Disability scale used for stroke management:
Barthel Index
Criteria assessed as part of Oxford Stroke classification:
- unilateral hemiparesis and/or hemisensory loss of face, arm and leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphagia
Total anterior circulation infarcts:
- middle and anterior cerebral arteries
- all 3 criteria present
Partial anterior circulation infarcts:
- smaller arteries of anterior circulation e..g upper or lower division of middle cerebral artery
- 2 of the above criteria are present
Lacunar infarcts:
- involves perforating arteries around internal capsule, thalamus and basal ganglia
- present with one of:
1. unilateral weakness of face and arm, arm and leg or all three
2. pure sensory stroke
3. ataxic hemiparesis
Posterior circulation infarcts:
- involves vertebrobasilar arteries
- present with 1 of following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia
Lateral medullar syndrome:
- aka Wallenberg’s syndrome
- ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
- contralateral: limb sensory loss
Weber’s syndrome:
- ipsilateral III palsy
- contralateral weakness
Definition of TIA:
transient episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischaemia without acute infarction
