Stroke Pathology

Question 1

What is a stroke

Answer 1

the experience of persisting neurological complications of cardiovascular disease
-NOT A DIAGNOSIS

Question 2

What is a TIA

Answer 2

A diagnosis based on clinical presentation and not pathology.
It is a brief episode of neurological dysfunction caused by focal brain or retinal ischaemia with symptoms lastin usually less than one hour and with no evidence of infarction
NOT BENIGN

Question 3

What are the two types of acute cerebrovascular syndrome

Answer 3

Ischaemic

Haemorrhagic

Question 4

How frequently are those who present with stroke ‘mimics’

Answer 4

one third of pts presenting may be ‘mimics’

Question 5

what score is used to help diagnose stroke

Answer 5

Rosier score

Score more than 0 suggests stroke is likely

Question 6

How long do stroke symptoms typically last

Answer 6

more than 24hours

Question 7

What is the oxford classification for cerebrovascular syndromes

Answer 7

Total anterior circulation syndrome
Partial anterior circulation syndrome
Lacunar syndrome
Posterior circulation syndrome

Question 8

What is TACS and how does it present

Answer 8

A stoke affecting the entire anterior circulation.
Hemiplegia w/ at east tow of face arm and leg +/- hemisensory loss
Homonymous hemianopia
Cortical signs (dysphasia, neglect)

Question 9

What is the sequelae of TACS

Answer 9

it is the most severe type of stroke

only about five percent of pts are alive and independent at one year

Question 10

What the clinical presentation of partial anterior circulation syndrome?

Answer 10

One of:

• 2 out of 3 features present in a TACs
• isolated cortical dysfunction such as dydphasia
• pure motor/sensory signs less severe than in lacunar syndromes eg monoparesis

Question 11

what is the prognosis of PACS

Answer 11

55 percent alive and independent at one year

Question 12

What is a lacunar syndrome (LACS)?

Answer 12

lacunar infarcts are small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in the brain stem,
can affects any two of: face, arm or leg

Question 13

What causes a LACS

Answer 13

occlusion of a single deep penetrating artery.

Question 14

What is the prognosis of LACS

Answer 14

best prognosis

60 percent alive and independent at one year

Question 15

What is posterior circulation syndrome (POCS)

Answer 15

Affects posterior circulation
Presents with :
-cranial nerve palsies
-conjugate eye movement disorders
-isolated homonymous hemianopia
-cortical blindness
-cerebellar deficits without ipsilateral motor/sensory signs (in contrast to Ataxic hemiparetic lacunar syndrome)

Question 16

What is the POCS prognosis

Answer 16

good- one year survival almost 60 percent

Question 17

Which is the dominant and non dominant hemisphere in most people

Answer 17

dominant is left in most people and non dominant ir right in most people

Question 18

Event in which cerebral hemisphere usually cause problems with language

Answer 18

left

Question 19

Events in which cerebral hemisphere usually cause problems with spatial awareness

Answer 19

right

Question 20

what is the most common cause of stroke

Answer 20

Atherothromboembolism

Question 21

What cardiac condition gives a big increase in the risk of stroke

Answer 21

AF - five fold increased risk

Question 22

how many strokes are due to af

Answer 22

1 in 6

Question 23

What are the different types of haemorrhagic stroke?

Answer 23

Primary intracerebral haemorrhage - hypertension, amyloid angiopathy
Secondary intracerebral haemorrhage- arteriovenous malformation, aneurysm, tumour

Question 24

What are the findings on MRI of primary intracerebral haemorrhage.

Answer 24

If lobar= cerebral amyloid angiopathy

if deep= more likely to be blood pressure related