Ageing - Stroke

Question 1

definition of a stroke?

Answer 1

rapidly developing signs/symptoms of a focal or global loss of brain function

Question 2

what are the ischaemic types of stroke?

Answer 2

atheroembolic
cardioembolic
small vessel thrombotic
other

Question 3

what are the haemorrhagic types of stroke?

Answer 3

intradural

• intracerebral
• SAH

subdural

extradural

Question 4

risk factors for stroke?

Answer 4

AF
thrombophilias
FHx
HT
smoking 
DM
dyslipidaemia
CVD
Hx of TIA/stroke

Question 5

features of a stroke?

Answer 5

neglect 
language problems
visual field change
dipolopia
weak
aphasia/dysarthria 
loss of sensation
confusion

Question 6

what are cerebellar signs?

Answer 6

dysdiadokenesis
ataxia
nystagmus
intention tremor
slurred/staccato speech
hypotonia

Question 7

what occurs if broca’s area is damaged? where is it?

Answer 7

struggles to speak

frontal lobe

Question 8

what occurs if wernicke’s area is damaged? where is it?

Answer 8

speaks but makes no sense

temporal lobe

Question 9

what do small vessel thrombotic strokes affect? what are risk factors?

Answer 9

small penetrating arteries

HT, age, lipids

LACUNAR strokes

Question 10

what are other causes of ischaemic strokes?

Answer 10

migraine
cocaine
shock
dissections

Question 11

what are paradoxical emboli?

Answer 11

pass through PFO
DVT/PE in origin
gets into arterial circulation and causes large vessel cardioembolic stroke

Question 12

causes of haemorrhagic stroke?

Answer 12

AVMs
hypertension
anticoagulants
cocaine

Question 13

who gets extradurals? signs?

Answer 13

young person playing sport
fluctuating consciousness
LEMON

Question 14

who gets subdurals? signs?

Answer 14

elderly
gradually declining consciousness
BANANA

Question 15

what does the posterior cerebral artery supply?

Answer 15

occipital

Question 16

what does the middle cerebral artery supply?

Answer 16

post central gyrus (sensory) parietal lobe

Question 17

what does the anterior cerebral artery supply?

Answer 17

pre central gyrus (motor) in the frontal lobe

broca’s (frontal) and wernicke’s (temporal)

Question 18

what is the anterior circulation of the brain?

Answer 18

those branching from the internal carotids

anterior and middle cerebral

Question 19

in a POCS, what areas of the brain are involved?

Answer 19

cerebellum

brainstem.

Question 20

in TACS, what three criteria must be present?

Answer 20

homonymous hemianopia
unilateral weakness
high cerebral dysfunction

Question 21

compared to TACS, what must POCS have?

Answer 21

two of
homonymous hemianopia
unilateral weakness
high cerebral dysfunction

Question 22

for LACS, what criteria must be present?

Answer 22

ONE of
sensory stroke
motor stroke
sensory motor stroke
ataxic hemiparesis

Question 23

for POCS, what criteria must be present?

Answer 23

ONE of
eye movement problems
homonymous hemianopia
cerebellar signs
bilateral sensory/motor defecit 
CN palsy

Question 24

Ix for stroke?

Answer 24

FBC, U+E,s LFTs, lipids, BM
prothrombin time
PTT
ECG
CT head (white = blood)

Question 25

what Ix should be done after a stroke?

Answer 25

carotid doppler ambulatory ECG echo

Question 26

who gets carotid endartectomy?

Answer 26

>70% narrowing on symptomatic side

Question 27

how long can thrombolysis be given after symptom onset?

Answer 27

4 and a half hours

Question 28

what is hyperacute stroke Tx?

Answer 28

AFTER head CT interpreted with no bleeds thrombolysis (alteplase) endovascular interventions (up to 6 hours) aspirin 300mg

Question 29

what is non hyperacute stroke Tx?

Answer 29

clopidogrel (aspirin + dypirimadole if can't tolerate) statins HT control swallow assessment physio OT

Question 30

what are stroke mimics?

Answer 30

``` hypo MS bell's palsy migraine sepsis syncope seizures ```

Question 31

what can be done as stroke prevention?

Answer 31

``` stop smoking wt loss exercise HT control lipid control reduce alcohol anticoag use ```

Question 32

definition of a TIA?

Answer 32

brief episode of neuro dysfunction caused by brain/retinal ischaemia

Question 33

what ophthalmology condition is classified as a stroke? how does it present?

Answer 33

CRAO (amaurosis fugax is the TIA) | painless visual loss in one eye

Question 34

why do TIAs resolve?

Answer 34

glial cells spared by transient ischaemia | tPA produced by own blood vessels

Question 35

causes of TIA?

Answer 35

``` atheroembolic cardioembolic small vessel hypercoagulable vasculitis vasospasm ```

Question 36

Ix for TIA?

Answer 36

``` FBC, U+Es, LFTs, lipids, BM prothrombin and APTT ECG opthalmoscopy MRI with diffusion carotid doppler ```

Question 37

Tx for a TIA?

Answer 37

anticoag (if cardioembolic) antiplatelet (atherosclerotic/embolic) e.g aspirin, clop, dipyrimadole statin HT control lifestyle modifications carotid endartectomy (≥70%)

Question 38

driving rules for stroke/TIA?

Answer 38

cant drive for 1 month after

Question 39

how does an anterior cerebral artery stroke present?

Answer 39

contralateral hemiparesis sensory loss worse lower limbs

Question 40

how does a middle cerebral artery stroke present?

Answer 40

``` contralateral hemiparesis sensory loss worse upper limbs homonymous hemianopia aphasia ```

Question 41

how does a posterior cerebral artery stroke present?

Answer 41

homonymous hemianopia with macular sparing

Question 42

how does a lacunar stroke present?

Answer 42

isolated: | hemiparesis, sensory loss, ataxia