Stroke diagnosis + classification Flashcards
Define a stroke
clinical syndrome characterised by rapidly developing clinical symptoms and/or signs of focal neurological deficit lasting more than 24 hours and thought to be of vascular origin
Describe the onset of a stroke
Sudden
haemorrhagic stroke can cause gradual worsening of symptoms but initial onset is still sudden
Stroke investigations
Bloods - FBC, U+E, LFTs, bone, clotting, blood sugar, cholesterol, ESR, antiphospholipid screen, vasculitis screen
ECG
CT head
CXR
+/- CT perfusion scan, MRI
Carotid dopplers/CT angiogram
ECHO + 24 hour tape +/- prolonged cardiac monitoring (to detect AF)
What are the 2 main types of stroke?
ischaemic
haemorrhagic
Causes of ischaemic stroke
Small deep infarcts (lacunar)
Cardio-embolic
Large artery infarcts
Artery-to-artery embolism
Extracranial occlusion
Poor collaterals
Intracranial atherosclerosis
Arterial dissection (carotids/vertebral)
Arteritis (eg. GCA)
Cryptogenic
Haemorrhagic stroke causes
Primary:
- amyloid angiopathy
- hypertensive
Secondary:
- AVM (arteriovenous malformation)
- aneurysm
- coagulopathy (warfarin)
Describe the Bamford (Oxford) classification of stroke
Lacunar:
- motor or sensory signs only
Partial anterior circulation (PACS) - 2 of following:
- motor or sensory signs
- cortical signs (eg. dysphasia, neglect)
- hemianopia (homonymous)
Total anterior circulation (TACS) - all of:
- motor or sensory signs
- cortical signs
- hemianopia (homonymous)
Posterior circulation:
- Hemianopia
- brain stem signs
- cerebellar signs
What is hemianopia?
loss of half of visual field
Total anterior circulation stroke signs
all of:
- motor or sensory loss
- cortical eg. dysphasia, neglect
- homonymous hemianopia
Partial anterior circulation stroke signs
2 of following:
- motor or sensory loss
- cortical eg. dysphasia, neglect etc.
- homonymous hemianopia
lacunar stroke signs
pure motor (internal capsule, pons)
pure sensory (thalamus)
sensorimotor
ataxic hemiparesis (pons)
movement disorders
Posterior circulation stroke signs
isolated hemianopia
brain stem signs
cerebellar ataxia
hemiparesis
hemisensory loss
vertigo, vomiting
diplopia (double vision)
facial weakness/numbness
dysphagia
respiratory failure
coma + death (locked in syndrome)
What is a TIA?
transient ischaemic attack
neurological signs that are consistent with a stroke that lasts for less than 24 hours
no damage on CT, may see some on MRI
What is the ABCD2 score used for and what are the components?
the risk of stroke in the 7 days following a TIA
Age>59 =1
BP systolic >140 and/or diastolic >90 =1
Clinical presentation:
- unilateral weakness =2
- speech disturbance =1
- other =1
Duration>59=2
10-59=1
0-9=0
Diabetes =1
Max score = 7
Score 4-5 = seven day risk >12%
Score 6-7 = seven day risk >30%
Name some stroke mimics
migraine
tumour
abscess
subarachnoid
subdural
cerebral vein thrombosis
epilepsy + Todd’s palsy
multiple sclerosis
myasthenia gravis
Bell’s palsy
functional
hypoglycaemia/other metabolic disorder
hypothermia
sepsis
old strokes who are unwell
dementia
If stroke onset is unknown what scan could you do to enable treatment?
CT perfusion scan
Thrombolysis risks
bleeding (into infarct, elsewhere in brain, rest of body)
anaphylactoid reaction om side of stroke
Haemorrhagic stroke risk factors
hypertension (long-term)
anticoagulants
liver failure (reduced clotting factor production)
arteriovenous malformation
Investigations to look for causes of ischaemic stroke
Echo (bubble echo?)
Carotid doppler
ECG
APLS antibodies (anticardiolipin, lupus anticoagulant)
Vasculitic screen
Fabry’s test (if pt young)
Name 2 investigations for haemorrhagic stroke
MRI (6 weeks post-haemorrhage)
CT angiogram
Complications of stroke
Aspiration pneumonia
DVT/PE
Pressure sores/ulcers
Seizures (more common in haemorrhagic)
Spasticity
Contractures
What is the driving advice after a stroke/TIA?
cannot drive for 1 month
recurrent TIAs = 3 months
HGV licence = 1 year TIA and stroke free
Seizures = 1 year (sometimes 6 months if only 1)
Must be physically fit to drive
no homonymous hemianopia
no neglect
no visual inattention
What is visual inattention?
failure of brain to pay attention to visual stimuli
they can see both sides of them but brain will only pay attention to one side at once
What is neglect?
loss of awareness of one side of body
