Stroke |X Flashcards
What is the WHO definition of stroke?
A clinical syndrome, of presumed vascular origin, typified by rapidly developing signs of focal or global disturbance of cerebral functions lasting more than 24 hours or leading to death
What are 2 causes of stroke? What % are they?
- Cerebral infarction - 80%
2. Cerebral haemorrage - 20%
What are 2 causes of cerebral bleeds?
- Intracranial haemorrhage
2. Sub-arachnoid haemorrhage
What are common risk factors for a cerebral infarction (5)?
What are 4 less common risk factors for a cerebral infarction?
Common
- Hypertension
- Atrial fibrillation
- Smoking
- Hypercholesterolaemia
- Diabetes
Less common
- Pro-thrombotic conditions
- Infective endocarditis
- Alcohol
- Intravenous drug use
What 4 lifestyle changes can you make to reduce the incidence of stroke?
- Good bp control
- Diabetes
- Hyperlipidaemia
- Stopping smoking
What are the ddx of a stroke?
- Subdural haematoma
- Epilepsy
- Hypoglycaemia
- Brain tumours
- Migraine
- Encephalitis
- Cerebral abscess
How do you differentiate between a subdural haematoma from a stroke (3)?
- Subdural haematoma usually more gradual onset with fluctuating s+s, drowsiness
- Often preceded by hx of trauma or blood thinning agents
- CT scan will make diagnosis
How do you differentiate epilepsy from a stroke (2)?
- Collateral history - Todd’s paresis can develop in those who have had a fit
- More rapid recovery (24 hours)
How do you differentiate hypoglycaemia from a stroke (1)?
Check BM
How do you differentiate brain tumours from a stroke (2)?
- Usually more insidious (days-weeks) with a stuttering or slowly progressive course
- CT scan shows tumour
How do you differentiate migraines from a stroke (2)?
- Migraine can occasionally cause transient weakness which rapidly improves
- Headache usually prominent feature
How do you differentiate encephalitis from a stroke (3)?
- May be an antecedent feature of infection
- Fitting and fluctuation are more common with encephalitis
- Electroencephalogram most useful
How do you differentiate cerebral abscess from a stroke (2)?
- Think cerebral abscess if infective features, longer prodrome, headache and reduced consciousness
- CT
What are the classic symptoms of stroke (6)?
- Speech disturbance
- Expressive/receptive dysphasia
- dysarthria - Other higher cortical dysfunction
- dysphagia
- parietal lobe signs - Limb weakness
- Sensory disturbance
- Visual impairment
- Brainstem symptoms
How fast is the onset of symptoms of stroke?
Abruptly, usually without warning
What is a transient ischaemic attack (TIA)?
A clinical syndrome characterised by an acute loss of focal cerebral or ocular function with symptoms lasting less than 24 hours (often only a few hours)
What is expressive dysphasia?
Understanding is preserved and the patient tries to convey meaningful responses to the questions asked. Reading and writing may be impaired, but understanding is intact.
What is receptive dysphasia?
Receptive dysphasia is due to a lesion in Wernicke’s area of the brain and results in the inability to understand language correctly.
What is dysarthria?
Dysarthria is motor disturbance of speech individuals know what they want to say, but cannot get the words out correctly, because of weakness to the tongue or facial muscles.
What are parietal lobe signs?
Sensory neglect - the patient has intact sensation when tested unilaterally but when confronted by bilateral stimuli, ignores the affected side
What are features of brainstem signs (3)?
- Cranial nerve palsies
- Cerebellar signs (ataxia)
- Locked-in syndrome
What are cerebellar signs (5)?
- Dysarthria
- Nystagmus
- Intention tremor
- Past pointing
- Broad based staggering gait
What is a commonly accepted method of classifying a stroke?
Oxford Stroke Classification
What are the classifications in the Oxford Stroke Classification?
*****8
- Lacunar (LACS)
- Motor or sensory deficit only - Partial anterior circulation (PACS)
- 2 of following: motor or sensory deficit; higher cortical dysfunction; hemianopia - Total anterior circulation (TACS)
All of: motor or sensory; cortical; hemianopia - Posterior circulation (POCS)
Isolated hemianopia; brain stem signs; cerebellar ataxia
