Stroke - Presentation and Investigation

Question 1

Be aware of the risk factors for stroke

Answer 1

Modifiable;

• High BP
• AF

Non-modifiable;

• Age
• Race
• Family history

Question 2

Describe the acute treatments for stroke

Answer 2

• Thrombolysis: given over minutes to make haemorrhage less likely
• Ambulance on blues
• Rapid triage upon arrival: imaging, specialist assessment
• Clot retrieval

Question 3

Outline the investigation of stroke

Answer 3

• FBC, lipids
• ECG
• Imaging: CT, MRI, carotid doppler

Question 4

Describe the symptoms of a stroke

Answer 4

Loss of;

• Power: fit, incontinence, loss of consciousness
• Sensation: weak/numb limb
• Speech; dysphasia, ataxia
• Vision: hemianopia, photophobia, nystagmus
• Coordination

Question 5

Wha does the carotid system supply?

Answer 5

Both hemispheres and the cortical deep white matter.

Question 6

What does the vertebra/basilar system supply?

Answer 6

The brain stem, cerebellum and occipital lobes.

Question 7

Describe causes of stroke

Answer 7

• Large artery atherosclerosis
• Cardioembolic: AF
• Small vessel (lacunar) occlusion
• Carotid dissection (rare)

Question 8

Describe total anterior circulation stroke (TACS)

Answer 8

• 20%
• Occlusion of proximal MCA or ICA
• Weakness, sensory loss, homonymous hemianopia, , dysphasia/dyspraxia

Question 9

Describe partial anterior circulation stroke (PACS)

Answer 9

• 35%
• Occlusion of MCA branches, more restricted
• Restricted motor/sensory function

Question 10

Describe lacunar stroke (LACS)

Answer 10

• 20%
• Types: pure motor, pure sensory, sensorimotor
• Silent, underdiagnosed

Question 11

Describe posterior circulation stroke (POCS)

Answer 11

• 25%
• Affect brainstem, cerebellar or occipital lobes
• Variable, complex presentation

Question 12

Describe the contraindications to thrombolysis

Answer 12

• Age (licenced for age <80)
• Stroke severity
• Tissue changes
• Infarct size
• Vessel occlusion
• DM
• BP
• Anti-coagulants

Question 13

Describe hemicraniectomy

Answer 13

• <60 years
• MCA territory Ischaemia stroke
• Complication of severe oedema: assymetric ventricular “butterfly”
• Offer within 48 hours of onset
• Remove part of skull to allow brain to swell
• Relieves pressure on brainstem

Question 14

Describe the secondary prevention of stroke/TIA

Answer 14

• Smoking cessation
• BP control
• Anti-platelet
• Statin
• Diabetic control