Theme 4: Clinical Approach to Stoke Disease

Question 1

what is the definition of a stroke?

Answer 1

a clinical syndrome characterised bu sudden onset of rapidly developing focal or global neurological disturbance which lasts more than 24 hours or leads to death

Question 2

what is the definition of a TIA?

Answer 2

transient (less than 24 hours) neurological dysfunction caused by focal brain (spinal cord or retinal) ischaemia whiteout evidences of infarction

Question 3

what is the criteria for diagnosis of Total anterior circulation syndrome (TACS) and partial anterior circulation syndrome (PACS)?

Answer 3

TACS- all 3 of: unilateral weakness (and/or sensory deficit) of at least 2 of face arm or leg, homonymous hemianopia (visual field deficit), and higher cortical deficit (dysphasia or visuospatial loss)
PACS- 2/3 of TACS criteria or isolated higher cortical deficit

Question 4

what is the criteria for diagnosis of lacunar syndrome (LACS)?

Answer 4

no loss of higher cortical functions. can be:
pure motor- affecting at least 2 of face arm or leg
pure sensory- affecting at least 2 of face, arm or leg
miseducating sensory motor

Question 5

what is the criteria for diagnosis of posterior circulation stroke (POCS)?

Answer 5

the presence of at least 1 of the following:

• cranial nerve palsy and contralateral moto/sensory deficit
• bilateral sensory/motor deficit
• conjugate eye movement disorder (horizontal gaze palsy)
• cerebellar dysfunction (nystagmus, vertigo ataxia)
• isolated homonymous hemianopia

Question 6

how do you distinguish between an ischaemic and Haemorrhagic stroke?

Answer 6

CT/MRI- a haemorrhage will show up in Haemorrhagic stroke, usually no change in ischaemic stroke initially

Question 7

what is the approach to investigating stoke?

Answer 7

1. CT/MRI- rule out haemorrhage, exclude other causes e.g tumour
2. establish underlying cause- BP, ECG, bloods, carotid ultrasound, echocardiogram (clot form AF)
3. rule out other causes- stroke mimics

Question 8

what is the approach to treating stoke?

Answer 8

1. initial management- thrombolysis if ischaemic and within the time window
2. secondary prevention- manage risk factors to prevent another stroke
3. rehabilitation- speech, swallowing, mobility, etc.

Question 9

how does haemorrhage appear on a CT?

Answer 9

white- high attenuation (hyper dense)

Question 10

how does an infarction appear on a CT?

Answer 10

not clearly evident on CT until 12 to 24 hours. attenuation decreases (gets darker) as stroke gets older

Question 11

what is the most common non-traumatic cause of a subarachnoid haemorrhage?

Answer 11

ruptured berry aneurysm

Question 12

what is the mechanism of action of altepase?

Answer 12

recombinant tissue plasminogen activator- binds to and activates plasminogen to plasmin which degrades plasmin and breaks up the thrombus

Question 13

what is the window of time where thrombolysis can be given?

Answer 13

must be given within 4.5 hours of symptom onset

Question 14

what are the contraindications for thrombolysis?

Answer 14

acute intracranial haemorrhage
history of intracranial haemorrhage
severe uncontrolled hypertension
serious head trauma or stroke in last 3 months
hyperglycaemia and hypoglycaemia
known intracranial arteriovenous malformation, neoplasm or aneurysm

Question 15

what is the FRAME model?

Answer 15

used to tailor communication for patients with language difficulties
Familiarise yourself with how the patient communicates
Reduce rate- speak slowly and clearly and give time for patient to process
Assist patient with communication
Mix communication methods
Engage with the patient as you normally would