Stroke - Presentation and Investigation Flashcards
What is a stroke?
A neurological deficit (loss of function):
- Of sudden onset
- Lasting more than 24hours
- Of vascular origin
What is a transient ischaemic attack?
Less than 24 hours deficiency in the brain
What are the cardinal symptoms of stroke?
Loss of:
- Power
- Speech
- Vision
- Coordination
What symptoms suggest haemorrhagic stroke?
Photophobia
What neurological consequences can occur pertaining to motor function?
Clumsy or weak limbs
What neurological consequences can occur pertaining to sensory function?
Loss of feeling
What neurological consequences can occur pertaining to speech function?
Dysarthria (slurred/slow speech) and dysphasia
What neurological consequences can occur pertaining to visual function?
Visuospatial problems, loss of vision in one eye, hemianopia (blindness in over half the visual field) and Gaze Palsy (inability to move the eyes synchronously)
What vascular system supplies most of the hemispheres and cortical deep white matter?
Carotid system
What vascular system supplies the brain stem, cerebellum and occipital lobes?
The vertebro-basilar system
What percentage of strokes are haemorrhagic?
15%
What is the commonest cause of cardioembolic stroke?
Atrial fibrillation
What is a stroke of the small blood vessels of the brain called?
Lacunar stroke
What characterises a Total Anterior Circulation Stroke (TACS)
Weakness, sensory deficiency, homonymous hemianopia, higher cerebral deficiency
What is the principle cause of TACS?
Occlusion of proximal MCA (middle cerebral artery) or ICA
What differentiates a TACS from a PACS?
More restricted cortical infarcts due to occlusion of branches of the MCA in PACS
What are the four types of lacunar strokes?
Pure motor (commonest), Pure sensory, Sensorimotor, Ataxic hemiparesis
What are the characteristics of a pure motor lacunar stroke?
Complete or incomplete weakness of one side of the body
What are the characteristics of an ataxic hemiparesis lacunar stroke?
Hemiparesis and ipsilateral cerebellar axtia, small infarcts in basal ganglia or pons
Intrinsic disease of single basal perforating artery (end arteries)
Often silent
What are the characteristics of a posterior circulation stroke?
Affecting brainstem, cerebellar and occipital lobes
Complex presentations
What are the tests/investigations useful when dealing with stroke?
Blood tests, ECG, CT, MRI, Doppler (blood flow/direction/profile/velocity)
