Stroke

Question 1

define stroke

Answer 1

the rapid permanent neurological deficit from cerebrovascular insult. Also defined clinically, as focal or global impairment of CNS function developing rapidly and lasting > 24 hrs

Question 2

how can a stroke be subdivided?

Answer 2

• either by infarction or haemorrhage

- or by position so anterior circulation or posterior circulation

Question 3

what is a TIA?

Answer 3

• a TIA is lasting less than 24 hours

- a stroke lasts longer than 24 hours

Question 4

what can ischaemic strokes be caused by?

Answer 4

• thrombosis
• emboli
• hypotension
• vasculitis
• cocaine

Question 5

what types of haemorrhage are there?

Answer 5

• intracerebral

- subarachnoid

Question 6

presenting symptoms of a stroke?

Answer 6

• sudden onset
• unilateral hemiparesis
• motor weakness
• visual field defects
• impaired coordination
• impaired consciousness
• swallowing problems

Question 7

how does an anterior cerebral artery present?

Answer 7

• contralateral hemiparesis
  and sensory loss
• lower extremity > upper

Question 8

how does a middle cerebral artery present?

Answer 8

contralateral hemiparesis and sensory loss

• upper extremity>lower extremity
• Contralateral homonymous hemianopia
• aphasia

Question 9

how does a posterior cerebral artery present?

Answer 9

• contralateral homonymous hemianopia with macular sparing

- visual agnosia

Question 10

how does posterior cerebral artery present?

Answer 10

• ipsilateral CN III palsy

- contralateral weakness of upper and lower extremities

Question 11

how does the posterior inferior cerebellar artery present?

Answer 11

• Ipsilateral: facial pain and temperature loss
• contralateral limb/torso pain and temperature loss
• ataxia
• nystagmus

Question 12

how does anterior inferior cerebellar artery present?

Answer 12

• similar to PICA

- difference is ipsilateral facial paralysis and deafness

Question 13

how does the ophthalmic artery present?

Answer 13

• Amaurosis fugax

sudden blindness

Question 14

how does the basilar artery present?

Answer 14

• presents with locked in syndrome

Question 15

how do lacunar strokes present?

Answer 15

• isolated hemiparesis
• hemisensory loss
• limb ataxia
• strong association with hypertension

Question 16

what are the investigations for stroke?

Answer 16

1. CT head scan  
Differentiates between haemorrhages and infarction
2. MRI brain 
3. Bloods 
4. ECG 
5. Echo 
6. Carotid doppler USS 
7. CT cerebral angiogram

Question 17

how to manage a hyper-acute stroke?

Answer 17

• if less than 4.5 hours from
• exclude haemorrhage using urgent imaging
• if the haemorrhage has been excluded then thrombolysis is offered.

Question 18

how to manage acute ischaemic stroke?

Answer 18

• Aspirin + Clopidogrel
• Heparin
• GCS monitorring
• Thromboprophylaxis

Question 19

how to manage a TIA?

Answer 19

• immediate aspirin 300mg
• more than one TIA discuss the need for urgent admission to stroke unit
• if patient has had suspected TIA in the last 7 days they need urgent assessment by physician.

Question 20

how to manage a haemorrhagic stroke?

Answer 20

• referral to neurosurgical consultation required
• anticoagulants and antithrombotics should be stopped
• blood pressure should be lowered

Question 21

what are the complications of strokes?

Answer 21

• Cerebral oedema
• immobility
• infections
• DVT
• cardiovascular events
• death

Question 22

what is the prognosis for patients with stroke?

Answer 22

• 10% mortality in the first month
• up to 50% of those who survive will be dependent upon others
• there is a 10% reoccurrence in one year
• the prognosis for hemorrhage is worse than ischemia