[2] Stroke Classification

Question 1

What are the two major types of stroke?

Answer 1

• Ischaemic

- Haemorrhagic

Question 2

What % of strokes are ischaemic?

Answer 2

87%

Question 3

What % of strokes are haemorrhagic?

Answer 3

13%

Question 4

What is an ischaemic stroke?

Answer 4

Reduced blood supply to an area of the brain resulting in tissue hypoperfusion

Question 5

What can be the underlying mechanisms leading to ischaemic stroke?

Answer 5

• Embolism
• Thrombosis
• Systemic hypoperfusion
• Cerebral venous sinus thrombosis

Question 6

How can an embolism cause ischaemic stroke?

Answer 6

Embolus from another part of the body (e.g. heart) obstructs a cerebral vessel resulting in hypoperfusion

Question 7

What condition can commonly lead to embolic ischaemic stroke?

Answer 7

AF

Question 8

How does thrombosis lead to ischaemic stroke?

Answer 8

Local formation of a blood clot in a cerebral vessel

Question 9

What is the most common cause of thrombosis leading to ischaemic stroke?

Answer 9

Rupture of an atherosclerotic plaque

Question 10

How can systemic hypoperfusion lead to ischaemic stroke?

Answer 10

Systemic hypotension leads to reduced blood supply

Question 11

When can systemic blood pressure drop low enough to cause systemic brain hypoperfusion leading to ischaemic stroke?

Answer 11

Cardiac arrest

Question 12

How can cerebral venous sinus thrombosis lead to ischaemic stroke?

Answer 12

Blood clots form in the veins that drain the brain leading to congestion and hypoxia damaging brain tissue

Question 13

When does haemorrhagic stroke occur?

Answer 13

When there is rupture of a blood vessel or abnormal vascular structure in the brain

Question 14

What are the two subtypes of haemorrhagic stroke?

Answer 14

• Intracerebral haemorrhage

- Subarachnoid haemorrhage

Question 15

What is an intracerebral haemorrhage?

Answer 15

Bleeding within the brain itself secondary to ruptured blood vessel

Question 16

What are the subtypes of intracerebral bleed?

Answer 16

• Intraparenchymal

- Intraventricular

Question 17

What is intraparenchymal bleeding?

Answer 17

Bleeding in the brain tissue

Question 18

What is intraventricular bleeding?

Answer 18

Bleeding in the brain ventricles

Question 19

What is a subarachnoid haemorrhage?

Answer 19

Bleeding that occurs outside of the brain tissue, between the pia mater and the arachnoid mater

Question 20

What is the most common underlying cause of a subarachnoid haemorrhage?

Answer 20

Rupture of berry aneurysm

Question 21

What are the three main (pairs of) arteries that supply the cerebrum?

Answer 21

• Anterior cerebral arteries
• Middle cerebral arteries
• Posterior cerebral arteries

Question 22

What region of the cerebrum is supplied by the ACA?

Answer 22

Anteromedial area

Question 23

What area of the brain is supplied by the MCA?

Answer 23

Lateral cerebrum

Question 24

What area of the brain is supplied by the PCA?

Answer 24

Medical and lateral areas of the posterior cerebrum

Question 25

What lobes of the brain are supplied by the ACA?

Answer 25

- Medial part of the frontal lobe | - Superior-medial parietal lobe

Question 26

What lobes of the brain are supplied by the MCA?

Answer 26

- Lateral frontal lobe - Lateral temporal lobe - Lateral parietal lobe

Question 27

What is the most common classification system used for ischaemic strokes?

Answer 27

Bamford classification (Oxford classification)

Question 28

How does the Bamford classification categorise strokes?

Answer 28

Based on the initial presentation and signs

Question 29

Does the Bamford classification require imaging?

Answer 29

No - it is purely clinical

Question 30

What are the types of strokes in the Bamford classification?

Answer 30

- TACS - PACS - POCS - LACS

Question 31

What does TACS mean?

Answer 31

Total Anterior Circulation Stroke

Question 32

What is a TACS?

Answer 32

A large cortical stroke affecting areas supplied by the ACA and MCA

Question 33

What is the criteria for a TACS?

Answer 33

All three of: - Unilateral weakness (or sensory deficit) of the face, arm and leg - Homonymous hemianopia - Higher cerebral dysfunction

Question 34

What are some examples of higher cerebral dysfunction seen in TACS?

Answer 34

- Dysphasia | - Visuospatial disorder

Question 35

What does PACS mean?

Answer 35

Partial Anterior Circulation Stroke

Question 36

What is a PACS?

Answer 36

A less severe form of TACS where only part of the anterior circulation (ACA and/or MCA)

Question 37

What is the criteria for a PACS?

Answer 37

Two of: - Unilateral weakness (or sensory deficit) of the face, arm and leg - Homonymous hemianopia - Higher cerebral dysfunction

Question 38

What does POCS mean?

Answer 38

POsterior Circulation Syndrome

Question 39

What is a POCS?

Answer 39

Stroke involving damage to the area of the brain supplied by the posterior circulation (e.g. brainstem and cerebellum)

Question 40

What is the criteria for a POCS?

Answer 40

One of: - Cranial nerve palsy and a contralateral motor/sensory deficit - Bilateral motor/sensory deficit - Conjugate eye movement disorder - Cerebellar dysfunction - Isolate homonymous hemianopia

Question 41

What is an example of a conjugate eye movement disorder that may be seen in a POCS?

Answer 41

Horizontal gaze palsy

Question 42

What are some examples of cerebellar dysfunction that may present in a POCS?

Answer 42

- Vertigo - Nystagmus - Ataxia

Question 43

What does LACS mean?

Answer 43

LACunar Syndrome

Question 44

What is a LACS?

Answer 44

A subcortical stroke occurring secondary to small vessel disease

Question 45

What does NOT occur in LACS?

Answer 45

Loss of higher cerebral function (e.g. dysphasia)

Question 46

What are the criteria for LACS?

Answer 46

One of: - Pure sensory stroke - Pure motor stroke - Sensori-motor stroke - Ataxis hemiparesis