Types of Stroke

Question 1

How is a stroke defined

Answer 1

> Rapid loss of brain function (usually lasting more than 24 hours)
No other cause but vascular

Question 2

Define a Transient Ischaemic attack

Answer 2

> TIA or Mini-stroke
sign that part of brain is not getting enough blood
usually lasts ~ 1 or 2 hours
*Signifies risk of more serious stroke in future

Question 3

Ischaemic stroke

Answer 3

> Lack of O2 due to atheroma of cerebral artery (plaque formation)/ thrombosis in brain or neck/ embolus that blocks vessel in brain or neck
80% of strokes - middle cerebral artery is most common (>posterior>anterior>brainstem = most serious)

> Classification (Bamford scale) = site + extent of lesion

• TACS = total anterior circulation stroke
• PACS = partial anterior circulation stroke
• POCS = posterior circulation syndrome
• LACS = lacunar syndrome (deep penetrating arteries)

Question 4

Ischaemic - TACS (Total anterior circulation stroke)

Answer 4

> Large cortical stroke in middle or anterior cerebral artery areas
Diagnosed by having all 3 of:
- Unilateral weakness (and/or sensory deficit) of face, arm and leg
- Homonymous hemianopia (loss of 1 part of visual field)
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 5

Ischaemic - PACS (Partial anterior circulation stroke)

Answer 5

> Cortical areas in middle/anterior areas = affected
Diagnosed by having 2 of:
- Unilateral weakness (and/or sensory deficit) of face, arm and leg
- Homonymous hemianopia (loss of 1 part of visual field)
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 6

Ischaemic - POCS (posterior circulation syndrome)

Answer 6

> Diagnosed by having one of:

• Cerebellar or brainstem syndromes
• Loss of consciousness
• Isolated homonymous hemianopia (loss of 1 part of visual field)

Question 7

Ischaemic - LACS (lacunar syndrome)

Answer 7

> Deep penetrating arteries
Subcortical stroke due to small vessel disease
no evidence of higher cerebral dysfunction
Diagnosis = 1 of:
- Unilateral weakness (and/or sensory deficit) of face and arm/ arm and leg/ all 3
- Pure sensory stroke
- Ataxic hemiparesis (only affecting one side)

Question 8

Ischaemic - Embolic stroke

Answer 8

> Completed stroke = sudden onset

> TIA = repeated small emboli - no infarction occurs

Question 9

Ischaemic - Thrombotic Stroke

Answer 9

> Completed stroke = Usually develops overnight
Developing stroke = over several days
TIA = sudden but full recovery
= 20% risk of full CVA within 1st 4 weeks

Question 10

Ischaemic Penumbra

Answer 10

> Area around clot which is damaged (not the dead/ischaemic tissue itself )

Question 11

Medical management for emboli/thrombus

Answer 11

> Medical Emergency - MRI/CT within 5-7 hours
Full stroke
- aspirin + anticoagulants + thrombolysis
TIA
- aspirin + prevention work (lifestyle change education)

\+ Other tests (what caused stroke)
- blood tests/angiography/echocardiology
\+ Surgery if necessary 
- thrombectomy (remove clot)
- carotid endarterectomy (scrape artery - remove fatty deposits)
- Stent insertion

Question 12

Haemorrhagic Stroke

Answer 12

> 20% of cases
> Types 
- Subarachnoid
- Intracerebral 
- Subdural 
- Extradural

Question 13

Haemorrhagic Stroke - Subarachnoid

Answer 13

> Bleeding into subarachnoid space
Due to
- tear of congenital aneurysm (sacular or fusiform)
- atriovenous malformation (abnormal tangle of connecting vessels - disrupts blood flow)
- trauma
Symptoms
- Sudden intense headache
- Vomiting
- Neck stiffness
- loss of consciousness
*High mortality rate (10% in 2 hours, 40% in 2 weeks)

Question 14

Haemorrhagic Stroke - Intracerebral

Answer 14

> Bleeding into deeper parts of brain 
> associated with hypertension - arterial walls weaken/ micro-aneurysms form and rupture 
> Symptoms 
- Severe headache
- Vomiting

Question 15

Haemorrhagic Stroke - Subdural

Answer 15

> Bleeding into subdural space
> usually due to trauma (possibly an interval between injury + symptoms)
> Symptoms
- Headache
- Drowsiness
- Stupor 
- Hemiparesis 
- Coma

Question 16

Haemorrhagic Stroke - Extradural

Answer 16

> Bleeding into extradural space

> Due to severe trauma - tears meningeal artery

Question 17

Haemorrhagic stroke - Medical Management

Answer 17

> Medical Emergency - MRI/CT scan ASAP
> Subarachnoid
- Surgery 
- Endoplastic procedures - clip/laser
> Extradural/subdural/intercranial
- treat hypertension (avoid draining if possible as creates infection risk)

+Other tests
- Blood tests/angiography (checks circulation)/ echocardiology
+Other meds
- osmotic agents (keep blood pressure low - diuretics)

Question 18

Symptoms

Answer 18

> Loss of consciousness - Haemorrhage
Headache - Haemorrhage (sometimes ischaemic)
Nausea/Vomiting - Haemorrhage (ischaemic if in posterior fossa)
Coma - Haemorrhage (if ischaemic = late on)
Stuttering Course - Ischaemic (rarely haemorrhagic)
Previous TIA’s - Ischaemic but not always