Medicine/Stroke

Question 1

Name the 4 types of Chronic Stroke

Answer 1

• Total anterior circulation infarct (TACI)
• Partial anterior circulation infarct (PACI)
• Lacunar circulation infarct (LACI)
• Posterior circulation infarct (POCI)

Question 2

What are the symptoms of a TACI

Answer 2

• Unilateral motor/sensory deficit, or both affecting at least two of face, arm or leg (opposite side to lesion)
• Higher cerebral dysfunction e.g. dysphasia, dyspraxia, neglect, dyscalculia (poor maths)
• Homonymous Hemianopia (opposite side to lesion)

Question 3

What are the symptoms of a PACI

Answer 3

• Two of the three components of a TACI

Or

• Pure motor or sensory deficit (not as much as LACI)

Or

• Pure higher cortical dysfunction e.g. dysfunction of speech, praxis, gnosis

Question 4

What are the symptoms of a LACI

Answer 4

• Pure motor or sensory deficit affecting at least two of: face, arm, leg
• Sensorimotor deficit
• Ataxic hemiparesis
  
  • Dysarthria, clumsy hand syndrome
• Acute onset movement disorder

Question 5

What are the symptoms of a POCI

Answer 5

• Isolated hemianopia
• Brainstem signs:
  
  • Difficulty breathing, speaking, chewing and swallowing.
  • Partial or complete hearing loss.
  • Blurred vision.
  • Weakness/Paralysis of the limbs.
  • Numbness or loss of sensation
• Cerebellar ataxia

Question 6

Name some stroke mimics

Answer 6

• Hypoglycaemia
• Neuropathies
• Migraine aura
• Parkinsons disease
• Alcohol intoxication
• Transient global amnesia

Question 7

Classification of stroke

Answer 7

1. Ischemic
   
   • Thrombotic
   • Embolic
   • Systemic hypoperfusion
2. Haemorrhagic

Question 8

Nice pathway for stroke

Answer 8

Question 9

Absolute Contra-indications for Thrombolytics in Stroke

Answer 9

• Acute intracranial haemorrhage on CT
• Clinical presentation suggests subarachnoid hemorrhage
• Neurosurgery, head trauma, or stroke in past 3 months
• Severe uncontrolled hypertension (>185/110)
• Hx of intracranial haemorrhage
• Known intracranial arteriovenous malformation, neoplasm, or aneurysm
• Active internal bleeding
• Suspected/confirmed endocarditis
• Known bleeding diathesis
• Abnormal blood glucose (<50 mg/dL)

Question 10

Relative Contra-indications for Thrombolytics in Stroke

Answer 10

• Only minor or rapidly improving stroke symptoms
• Major surgery or serious non-head trauma in the previous 14 days
• History of gastrointestinal or urinary tract hemorrhage within 21 days
• Seizure at stroke onset
• Recent arterial puncture at a noncompressible site
• Recent lumbar puncture
• Post myocardial infarction/pericarditis
• Pregnancy

Question 11

Additional warnings for Thrombolytics in Stroke

Answer 11

• Age >80 years
• History of prior stroke and diabetes
• Any active anticoagulant use (even with INR <1.7)
• CT shows multilobar infarction (hypodensity >1/3 cerebral hemisphere)

Question 12

Indications for thrombolysis in stroke

Answer 12

• Aged over 18 (there is no upper age limit)
• Clinical symptoms of a stroke lasting for over 30 mins
• Clear time of symptom onset
• Sufficient time available to administer thrombolysis <4.5 hours of symptom onset

Question 13

Stroke types, brief description, anatomy, prognosis

Answer 13