FN: Stroke Presentation

Question 1

Total Anterior Circulation Stroke:

Answer 1

• Infarct in carotid/MCA, ACA territory

Question 2

Total Anterior Circulation Stroke: presentation

Answer 2

2. Hemiparesis (contralateral) and/or sensory deficit (>2 + of face, arm and leg)
3. Homoymous hemianopia (contralateral)
4. Higher cortical dysfunction
   a. Dominant L usually: dysphasia
   b. Non-dominant: hemispatial neglect

Question 3

Posterior Circulation Stroke (POCS)

Answer 3

→ Infarct in vertebrobasilar territory

Question 4

Posterior Circulation Stroke (POCS) presentation any of:

Answer 4

1. Cerebellar syndrome
2. Brainstem syndrome
3. Contralateral homonymous hemianopia

• LAterla Medullary syndrome
• Millard-Gubler syndrome
• Locked-in Syndrome

Question 5

Partial Anterior Circulation Stroke (deficit less dense and/or incomplete).

Answer 5

• Infarct in carotid/MCA and ACA territory

Question 6

Partial Anterior Circulation Stroke (deficit less dense and/or incomplete).
Presentation: 2/3 of TACS criteria

Answer 6

1. Hemiparesis (contralateral) and/or sensory deficit (>2 + of face, arm and leg)
2. Higher cortical dysfunction
   a. Dominant L usually: dysphasia
   b. Non-dominant: neglect, constructional apraxia

Question 7

Lacunar Stroke (LACS)

Answer 7

→ Small infarcts around basal ganglia, internal capsule, thalamus and pons

Question 8

LACS Absence of

Answer 8

• Higher cortical dysfunction
• Homonymous hemianopia
• Drowsiness
• Brainstem signs

Question 9

Lacunar 5 syndromes

Answer 9

• Pure motor: post. Limb of internal capsule – commonest
• Pure sensory: post. Thalamus (VPL)
• Mixed sensorimotor: internal capsule
• Dysarthria/clumsy hand
• Ataxic hemiparesis: ant. Limb of internal capsule – weakness + dysmetria

Question 10

LAteral Medullary Syndrome/Wallenbergs syndrome

Answer 10

PICA or vertebral artery

Question 11

LAteral Medullary Syndrome/Wallenbergs syndrome features

Answer 11

DANVAH
Dysphagia
Ataxia (ipsilateral)
Nystagmus (ipsilateral)
Vertigo
Anaesthesia:
1. Ipsilat facial numbness + absent corneal reflex
2. Contralaterl pain loss

Horner’s syndrome

Question 12

Millard-Gubler Syndrome

Answer 12

Pontine infarct
6th and 7th CN nuclei+ corticospinal tracts
1. Diplopia
2. LMN facial palsy + loss of corneal reflex
3. Contralateral hemiplegia

Question 13

Locked in syndrome

Answer 13

Pt. is aware and cognitively intact but completely paralysed except for the eye muscles

Question 14

Locked in syndrome causes

Answer 14

Ventral pons infarction: basilar artery

Central pontine myelinolysis: rapid correction of hyponatraemia

Question 15

Stroke differential

Answer 15

Head injury ± haemorrhage
High or low glucose
SOL
Hemiplegic migraine
Todd's palsy
Infections: encephalitis, abscessess, Toxo, HIV, HTLV
Drugs: e.g. opiate overdose