Strokes for finals folks

Question 2

One sided facial weakness, homonymous hemianopia and slurred speech

Answer 2

Total anterior circulation stroke

All 3 of:

1. One-sided motor +/- sensory loss in face, arms and leg
2. Loss of same half of vision in both eyes
3. Loss of higher function eg speech

Anterior and middle cerebral arteries

Question 3

What symptoms indicate a lacunar stroke?

Answer 3

Any of

Pure sensory loss

Unilateral motor +/- sensory loss

Ataxic weakness bilaterally

Question 4

An isolated homonoymous hemianopia can indicate what kind of stroke? What two other symtpoms does this present with?

Answer 4

Posterior infarct circulation syndrome

• Brainstem syndromes
• Loss of consciousness
• Isolated homonymous hemianopia

Supplied by vertebrobasilar arteries

Question 5

Stroke by anatomy

Upper > Lower contralateral hemiparesis

+/- sensation loss

Answer 5

Anterior cerebral artery

Question 6

Stroke by anatomy

Lower > Upper Contralateral weakness

Homonymous hemianopia

Answer 6

Middle Cerebral Artery

Question 7

Stroke by anatomy

Visual agnosia

Contralateral homonymous hemianopia

Answer 7

Posterior cerebral artery

Question 8

Stroke by anatomy

Contralateral extremity weakness

Ipsilateral CNIII palsy

Answer 8

Smaller branches of PCA

Known as Weber’s syndrome

Question 9

Stroke by anatomy

Locked in Syndrome

Answer 9

Basilar arteries

Question 10

Stroke by anatomy

Pain/temperature loss in limb/torso

IL facial pain + loss

Answer 10

Posterior Inferior Cerebellar Artery

Question 11

CL Limb/torso pain, temp loss

IL facial pain +/- motor loss

IL deafness on same side as facial pain

Answer 11

Anterior inferior cerebellar artery

PICA + IL facial paralysis and or deafness

Question 12

How do you investigate a stroke?

Answer 12

1st line: CT to determine if haemorrhagic

GS: Diffusion weighted MRI if unclear

Question 13

4 hour stroke history without haemorrhage on CT.

Initial treatment?

Definitive treatment?

Answer 13

Alteplase as under 4.5 hours of symptom onset

thrombectomy as within 6 hours (if angiography confirms occlusion of ACA/MRA)

Question 14

Which ischaemic stroke patients get thrombectomy?

Answer 14

Image confirmation of prox anterior (ACA/MCA) occlusion

Presenting <6 hours of onset

Presenting 6-24 hours onset + imaging evidence of salvageable tissue

Question 15

When should 300mg aspirin for 14 days be given to stroke patients?

Answer 15

ASAP within 24 hours

BUT AFTER IMAGING + TREATMENT

Question 16

Which ongoing conditions contraindicate thrombolysis in stroke?

Answer 16

Current: Pregnancy, oesophageal varices, uncontrolled HTN (>200/100), seizure at stroke start, IC neoplasm

Question 17

What contraindicates a stroke if it occured in the past 7 days?

Answer 17

7 days: Lumbar puncture

Question 18

When is a GI bleed a contraindication to thrombolysis?

Answer 18

3 weeks: GI bleeding

Question 19

When is a previous stroke/TBI contraindication to thrombolysis?

Answer 19

3 months: Stroke/TBI

Question 20

What is a contraindication to thrombolysis regardless of when it happened?

Answer 20

At any point: Previous IC haemorrhage

Question 21

What does secondary stroke prevention entail?

Answer 21

HALTSS

Hypertension: Control 2 weeks post stroke

Antiplatelets: 75mg clopidogrel daily 2 weeks post stroke

Lipids: Atorvostatin 20-80mg once nightly

Tobacco: Cessation

Sugar: Diabetic screening and management

Surgery: >50% stenosis in ipsilateral carotid artery stenosis

Question 22

What antiplatelet options are there for stroke if clopidogrel cannot be taken?

Answer 22

Aspirin + MR dipyridamole

MR dipyridamole alone if aspirin not tolerated