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Neurology > Stroke Syndromes > Flashcards

Stroke Syndromes Flashcards

1
Q

What are the key clinical features of a MCA stroke?

A

Contralateral hemiparesis (upper>lower limbs; forehead spared)
Contralateral hemisensory loss (all modalities)
Contralateral homonymous hemianopia
Aphasia (if dominant hemisphere affected)

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2
Q

What are the key clinical features of an ACA stroke?

A

Contralateral hemiparesis (lower>upper limbs; forehead spared)
Contralateral hemisensory loss (all modalities)
Dysarthria
Urinary incontinence

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3
Q

What are the key clinical features of a PCA stroke?

A

Homonymous hemianopia with macula sparing
Visual agnosia
Alexia without agraphia

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4
Q

Weber’s syndrome is caused by disease of which vessels? What are the key clinical features?

A

Perforating arteries to the midbrain from PCA

Ipsilateral CN III palsy + Contralateral limb hemiparesis

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5
Q

Lateral Medullary Syndrome is caused by disease of which vessel? What are the key clinical features?

A

Posterior Inferior Cerebellar Artery (PICA)

Ipsilateral loss of pain and temperature sensation in face
Contralateral loss of pain and temperature in body

Nystagmus 
Ataxia
Dysphagia
Horner's syndrome
Nausea + vomiting 
Hoarse voice 
Vertigo
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6
Q

What syndrome would result after complete, bilateral occlusion of basilar arteries? What are the key clinical features?

A

Locked-in Syndrome

Paralysis of all muscles except extra-occular muscles

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7
Q

What areas of the brain and vessel is most likely to be affected in a patient presenting with:

  • hemiparesis (right)
  • lateral gaze weakness (left)
  • facial weakness (left)
A

Left Pons
Branches of Basilar artery

This is ventral pontine syndrome:
Contralateral hemiparesis
Ipsilateral CN VI palsy
Ipsilateral CN VII palsy

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8
Q

What is amaurosis fugax and what vessel is involved in it’s development?

A

Temporary monocular blindness

Retinal artery occlusion

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9
Q

What are the criteria for a TACI?

A
  • Contralateral hemisensory loss and hemiplegia
  • Contralateral homonymous hemianopia
  • Evidence of higher dysfunction (e.g. inattention/neglect if non-dominant side), aphasia (if dominant side),
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10
Q

What are the criteria for a PACI?

A

2 of:

  • Contralateral hemisensory loss and hemiplegia
  • Contralateral homonymous hemianopia
  • Evidence of higher dysfunction

OR

Motor loss of an isolated area (e.g. Leg weakness only)

OR

Higher dysfunction only

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11
Q

What are the criteria for a POCI

A

Isolated homonymous hemianopia

OR

Ipsilateral cerebellar syndrome features (ataxia, nystagmus, dysarthria)

OR

Cranial nerve palsy and contralateral motor/sensory deficit

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12
Q

What are the criteria for a LACI?

A

Pure Motor
-Unilateral paralysis involving at least 2 of face/arm/leg

Pure Sensory
-Unilateral sensory loss involving at least 2 of face/arm/leg

Sensorimotor

  • Combination of pure motor and pure sensory
  • Without visual field defect or higher dysfunction

Ataxic hemiparesis

  • Ipsilateral cerebellar signs and hemiparesis
  • with/without dysarthria
  • Without visual field defect or higher dysfunction
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13
Q

Name the common stroke mimics

A 
Seizure
Migraine aura 
Brain tumour
Subdural haematoma 
MS
Bell's palsy

Sepsis
Hypo-/hyper- glycaemia/calcaemia/natraemia
Glaucoma

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14
Q

What screening tool can be used to assess likelihood of a stroke?

A

ROSIER

>0 = stroke likely

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15
Q

What is the most appropriate 1st line investigation for a patient presenting with a likely stroke? What is the exception to this?

A

Non-contrast CT head scan

Exception is if patient is presenting >7 days after symptoms, when a diffusion-weighted MRI is better

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16
Q

What other baseline investigations should be conducted?

A

Bloods:

  • FBC, U&Es, LFTs, TFTs, CRP
  • glucose
  • INR if anticoagulated
  • lipids

BP
ECG

17
Q

When should a carotid USS+doppler be conducted? How is it interpreted?

A

If the patient would be suitable for endarterectomy

> 70% ECST (or 50% NASCET) stenosis indicates likely recurrence

18
Q

Give the 4 criteria required for a patient to be eligible for thrombolysis

A

1) >18yrs
2) symptoms and signs of acute stroke
3) within 4.5hrs symptom onset
4) haemorrhage excluded on non-contrast CT

19
Q

What are the major contraindications to thrombolysis?

A
  • Active bleeding
  • Previous intracranial haemorrhage
  • Intracranial neoplasm
  • Seizure at stroke onset
  • Stroke/brain injury within 3 months
  • LP within 3 days
  • Pregnancy
  • Uncontrolled hypertension (>200/120)
20
Q

What and how is thrombolysis given? Are any tests required after thrombolysis?

A

IV Alteplase

Repeat head CT 24hrs later to ensure no haemorrhage

21
Q

What is an equally effective alternative to thrombolysis, available in some parts of the UK?

A

Clot revival (mechanical thrombectomy)

22
Q

How do you manage a patient who is ineligible for thrombolysis?

A

Immediate aspirin 300mg (oral or rectal)

23
Q

How long is aspirin therapy continued after a stroke and at what dose?

A

2 weeks of 300m

24
Q

Describe secondary prevention interventions after a stroke

A

Start life-long Clopidogrel when aspirin therapy is withdrawn

Satin if cholesterol raised
Good BP and glycaemic control

25
Q

When should anticoagulation be started after a stroke secondary to AF?

A

14 days

26
Q

How do you manage a haemorrhagic stroke?

A

Antihypertensives if BP> 180 systolic or 130 diastolic

27
Q

What are the 3 main risk factors for haemorrhagic stroke?

A

1) Hypertension
2) Arteriovenous malformations
3) Secondary to cerebral infarction

28
Q

what are the 3 main causes of TIA?

A

1) cardioembolism
2) Intracranial thromboembolism
3) extracranial thromboembolism (e.g. carotid artery embolism)

29
Q

How do you treat a TIA?

A

300mg aspirin immediately and continued for 2 weeks

Then lifelong Clopidogrel 75mg

Secondary prevention

30
Q

What score can be used to assess risk of stroke following TIA?

A

ABCD2

Neurology (4 decks)

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