Stroke / CVA

Question 1

Definition of stroke

What scan is required to make diagnosis…………..?

A Transient Ischaemic Attack (TIA) is ……. Caused by?

Risk Factors of stroke in adults ?

Risk factors in children?

Answer 1

Stroke
A stroke can be defined as a sudden global or focal neurological deficit resulting from spontaneous haemorrhage or infarction of the central nervous system, with objective evidence of an infarction or haemorrhage, irrespective of the duration of clinical symptoms.

A CT or MRI scan is required to make the diagnosis and exclude other intracranial lesions that could present similarly.

A Transient Ischaemic Attack (TIA), on the other hand, is a transient episode of neurologic dysfunction caused by
— focal brain,
— spinal cord, or
— retinal ischemia.

There is no objective evidence of acute infarction in the affected region of brain or retina.

In adults,
— hypertension,
— diabetes,
— dyslipidaemia,
— atrial fibrillation and smoking, increase the risk for strokes.

In children
— sickle cell disease and
— cyanotic heart disease are important risk factors for strokes.

Patients should ideally have multidisciplinary care.

Question 2

Causes

Answer 2

Causes
y Cerebral infarction
y Thrombosis of a cerebral vessel
y Embolism from a distant site (e.g. atrial fibrillation)
y Intracerebral haemorrhage y Subarachnoid haemorrhage

Question 3

Signs and Symptoms of Stroke

Answer 3

Symptoms
y Weakness of one side of the body including the face y Inability to rise up from a sitting or lying position
y Sudden fall/collapse
y Loss of speech
y Loss of vision
y Severe headache and/or neck pain (subarachnoid haemorrhage) y Unconsciousness in some patients
y Seizures
Signs
y Paralysis of a limb
y Facial paralysis (lower half)
y Initialflaccidityoflimbs,butlaterspasticityandexaggeratedreflexes y Hemianopia (loss of one-half of visual field)
y Hemi-anaesthesia (loss of sensation of one-half of body)
y Extensor plantar response
y Dysarthria/dysphasia (alteration of speech)
y Neck stiffness (in subarachnoid haemorrhage)

Question 4

Investigations

Answer 4

Investigations
y FBC, ESR
y Blood glucose
y Serum lipid profile
y Blood urea, electrolytes and creatinine
y Uric acid
y ECG
y CT scan/MRI of the head
y Chest X-ray

Question 5

Treatment

Answer 5

STG page 130

Answer 6

Referral Criteria
Patients with worsening symptoms and signs should be urgently referred for specialist evaluation and care. All stable patients with neurological deficits should be referred to a speech therapist, occupational therapist or physiotherapist as appropriate.