Stroke

Question 1

Define stroke:

Answer 1

An experience of persisting neurological complications of a cardiovascular event.
It is an abrupt onset lasting more than 24 hours

Question 2

List the different types of stroke form most to least common:

Answer 2

Ischaemic - 85%
Haemorrhagic - 10%
Subarachnoid - 5%

Question 3

What is the difference between a TIA and a stroke?

Answer 3

A TIA will never have deficits lasting more than 24 hours, whereas in a stroke, the deficits will persist.

Question 4

How many stroke like presentations tend to be stroke mimics?

Answer 4

1/3rd

Question 5

What are some causes of stroke mimics?

Answer 5

Seizures
Sepsis
Metabolic
Toxic
Pre-syncope
Delirium
Dementia

Question 6

What scoring system can be used to differentiate between a stroke and a stroke mimic?

Answer 6

Rosier’s Score
>0 = stroke likely
= 0 means stroke less likely

Question 7

What scoring system is used to assess risk of ischemic stroke?

Answer 7

CHADS-VASc

Question 8

List some causes of ischaemic stroke:

Answer 8

Cardioembolic
Atheroembolic
Atrial Fibrillation
Small vessel occlusion

Question 9

List some risk factors for ischaemic stroke:

Answer 9

High Cholesterol
Smoking
Obesity
A. fib
Asian

Question 10

List the main causes of haemorrhagic stroke:

Answer 10

Aneurysms
Amyloid angiopathy
Hypertension
Structural Abnormality

Question 11

What is the main cause of a subarachnoid haemorrhage/stroke?

Answer 11

Berry aneurysm

Question 12

What are some symptoms that would be suggestive of a subarachnoid haemorrhage?

Answer 12

Sudden:
(Occipital) Headache
Neck stiffness
Kernig's Sign
Vomiting
Loss of consciousness - (drowsiness may last a few days)

Question 13

What is the process of hemorrhagic to ischaemic stroke in a subarachnoid stroke?

Answer 13

Haemorrhage leads to irritation causing vasospasm which causes an ischaemic attack

Question 14

What artery does the anterior circulation branch off?

Answer 14

Internal carotid

Question 15

Which of the anterior vessels is larger?

Answer 15

Middle cerebral artery

80% of the blood flows through here

Question 16

Does the anterior cerebral artery supply the medial or lateral aspect of the cerebral hemisphere?

Answer 16

Medial

Question 17

What is the most common type of ischaemic stroke?

Answer 17

Cardioembolic

Question 18

An anterior circulatory stroke will result in weakness of the ipsilateral/contralateral side of the body?

Answer 18

Contralateral

Question 19

What vessels supply to posterior circulation?

Answer 19

Vertebral

Basilar

Question 20

Where is a common site for spontaneous intra-cerebral haemorrhage and why is it significant?

Answer 20

Basal ganglia and internal capsule - lenticular striate from MCA
This area does not have collateral blood supply, therefore it is high risk of suffering from tissue damage if blood supply is compromised

Question 21

Which of the stroke syndromes carries the worst prognosis?

Answer 21

Total Anterior Cerebral Stroke

5% full recovery

Question 22

Which of the stroke syndromes carries the best prognosis?

Answer 22

Lacunar Stroke

Question 23

List the symptoms of a TAC stroke:

Answer 23

Hemiplegia involved at least 2 of the following: legs, arms and face
Homonymous hemianopia
Visospatial dyspraxia
Cortical signs e.g. dysphagia and neglect

Question 24

What are some of the clinical features of a Partial anterior cerebral stroke?

Answer 24

it will either have 2/3 signs from a TAC
OR
Isolated cortical dysfunction e.g dysphasia
OR
Pure motor/sensory signs which are less severe than a lacunar stroke

Question 25

What clinical features would be seen in a Posterior artery stroke? (POCS)

Answer 25

``` Cranial nerve deficits with contralateral hemiparesis OR Sensory deficit OR bilateral stroke Conjugate eye movements Cerebellar deficits ```

Question 26

What features are not seen in POCS which are seen in a Lacunar stroke?

Answer 26

Ataxia hemiparesis

Question 27

Stroke in which hemisphere is likely to affect the patients language, number skills, wriitng skills and reasoning?

Answer 27

Left side of brain | the dominant side is almost always left

Question 28

What is affected should a stroke occur in the RHS (non dominant) hemisphere?

Answer 28

Artistic awareness Spatial orientation creativity music

Question 29

A stroke in the right/left hemisphere will require more intensive rehab?

Answer 29

Left

Question 30

What are the clinical features of a lacunar infarct?

Answer 30

Ataxic hemiparesis Pure motor / pure sensory loss of 2/3 of arms legs and face Dysarthria and clumsy hands

Question 31

Where are berry aneurysms common?

Answer 31

Junction of posterior communicating with internal carotid OR junction of anterior communicating with the anterior cerebellar artery OR bifurcation of middle cerebral artery

Question 32

What other co morbidities are associated with Berry aneurysms?

Answer 32

Polycystic kidneys Ehlers-Danlos syndrome Coartication of aorta

Question 33

What is the appropriate management for a subarachnoid haemorrhage?

Answer 33

Maintain cerebral perfusion through IV fluids Nimodipine - prevents vasospasm Endovascular coiling - preferred over clipping

Question 34

What investigation should you do in suspected subarachnoid haemorrhage and why?

Answer 34

Catheter or CT angiography | identifies if single or multiple aneurysms

Question 35

List some complications of subarachnoid haemorrhage:

Answer 35

``` Rebleed Cerebral ischaemia due to vasospasm Hydrocephalus Hyponatraemia Increased risk of new aneurysms ```

Question 36

What is the main cause of a cardioembolic stroke?

Answer 36

Atrial fibrillation

Question 37

When can thrombolysis be used in the management of a stroke?

Answer 37

If symptoms presented less than 4.5 hours ago

Question 38

Quadriplegia and "locked in" syndrome would suggest a stroke where?

Answer 38

Brainstem

Question 39

Once hemorrhagic stroke has been excluded and thrombolysis potentially given, what is the next most appropriate management?

Answer 39

Aspirin 300mg

Question 40

What medication will patients be on long term post an ischaemic stroke?

Answer 40

Anti-platelets Or Anti-coagulants

Question 41

What can be done to manage a hemorrhagic stroke?

Answer 41

No specific interventions | Mainly supportive management