Stroke

Question 1

List typical stroke features

Answer 1

• Focal
• Sudden onset
• Vascular territory hypoperfusion can explain collection of symptoms

THEY DO NOT MIGRATE (unless capsular warning syndrome) and do no stereotype

Question 2

Classify a TACS using the Oxford stroke classification

Answer 2

ICA or proximal MCA occlusion

• Hemiparesis
• Higher cortical dysfunction e.g. dysphasia, visuospatial neglect
• Homonymous hemianopia

Question 3

Classify a PACS using the Oxford stroke classification

Answer 3

Branch of the MCA occlusion

• Isolated higher cortical dysfunction OR
  any TWO of hemiparesis, higher cortical dysfunction and homonymous hemianopia

Question 4

Classify a POCS using the Oxford stroke classification

Answer 4

Vertebral, basilar, cerebellar or posterior cerebral artery occlusion

• Isolated hemianopia, brainstem or cerebellar syndromes

Question 5

Classify a LACS using the Oxford stroke classification

Answer 5

Small penetrating artery occlusion - usually lenticulostriate branches of MCA or supply to brainstem or deep white matter

• Pure motor stroke OR
• Pure sensory stroke OR
• Sensorimotor stroke OR
• Ataxic hemiparesis OR
• Clumsy hand dysarthria

Question 6

What complications can you get following a stroke?

Answer 6

• Recurrent stroke
• Complications due to immobility
• Raised ICP
• Infections
• MOOD disorder
• Secondary epilepsy

Question 7

What steps are involved in the treatment/intervention/information stages?

Answer 7

• Admission onto a stroke unit
• Revascularisation therapy
• Optimising physiology and surveillance, prevention and detection of early post stroke complications
• Nutritional support
• Secondary prevention and rehabilitation

Question 8

What does revascularisation therapy involve?

Answer 8

• IV Alteplase - 4.5hr window - rapid assessment to confirm stroke assessment and exclude contraindication, get CT to exclude haemorrhagic stroke and give bolus)
• Thrombectomy - 6hr therapy window
  This is used in selected patients with large vessel occlusion - CT angiogram

Question 9

Give examples of secondary prevention

Answer 9

• Role of aetiology must be understood
• Antithrombotic therapy
• BP control <130/80
• Lipid control total cholesterol less than 4 and LDL <2
• HbA1c <7
• Potentially a carotid endarterectomy?
• Lifestyle modifications e.g. smoking cessation, sleep optimisation, exercise, weight loss

Question 10

Within what timeframe would you perform a CT in a patient who has had a fall and is on warfarin?

Answer 10

CT within 8 hours