What is a stroke
the experience of persisting neurological complications of cardiovascular disease
-NOT A DIAGNOSIS
What is a TIA
A diagnosis based on clinical presentation and not pathology.
It is a brief episode of neurological dysfunction caused by focal brain or retinal ischaemia with symptoms lastin usually less than one hour and with no evidence of infarction
NOT BENIGN
What are the two types of acute cerebrovascular syndrome
Ischaemic
Haemorrhagic
How frequently are those who present with stroke ‘mimics’
one third of pts presenting may be ‘mimics’
what score is used to help diagnose stroke
Rosier score
Score more than 0 suggests stroke is likely
How long do stroke symptoms typically last
more than 24hours
What is the oxford classification for cerebrovascular syndromes
Total anterior circulation syndrome
Partial anterior circulation syndrome
Lacunar syndrome
Posterior circulation syndrome
What is TACS and how does it present
A stoke affecting the entire anterior circulation.
Hemiplegia w/ at east tow of face arm and leg +/- hemisensory loss
Homonymous hemianopia
Cortical signs (dysphasia, neglect)
What is the sequelae of TACS
it is the most severe type of stroke
only about five percent of pts are alive and independent at one year
What the clinical presentation of partial anterior circulation syndrome?
One of:
- 2 out of 3 features present in a TACs
- isolated cortical dysfunction such as dydphasia
- pure motor/sensory signs less severe than in lacunar syndromes eg monoparesis
what is the prognosis of PACS
55 percent alive and independent at one year
What is a lacunar syndrome (LACS)?
lacunar infarcts are small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in the brain stem,
can affects any two of: face, arm or leg
What causes a LACS
occlusion of a single deep penetrating artery.
What is the prognosis of LACS
best prognosis
60 percent alive and independent at one year
What is posterior circulation syndrome (POCS)
Affects posterior circulation Presents with : -cranial nerve palsies -conjugate eye movement disorders -isolated homonymous hemianopia -cortical blindness -cerebellar deficits without ipsilateral motor/sensory signs (in contrast to Ataxic hemiparetic lacunar syndrome)
What is the POCS prognosis
good- one year survival almost 60 percent
Which is the dominant and non dominant hemisphere in most people
dominant is left in most people and non dominant ir right in most people
Event in which cerebral hemisphere usually cause problems with language
left
Events in which cerebral hemisphere usually cause problems with spatial awareness
right
what is the most common cause of stroke
Atherothromboembolism
What cardiac condition gives a big increase in the risk of stroke
AF - five fold increased risk
how many strokes are due to af
1 in 6
What are the different types of haemorrhagic stroke?
Primary intracerebral haemorrhage - hypertension, amyloid angiopathy
Secondary intracerebral haemorrhage- arteriovenous malformation, aneurysm, tumour
What are the findings on MRI of primary intracerebral haemorrhage.
If lobar= cerebral amyloid angiopathy
if deep= more likely to be blood pressure related
