True or false: The majority of strokes are ischaemic.
True
15-20% of strokes are haemorrhagic; 80-85% are ischaemic.
True or false: for a patient to be diagnosed with a stroke, their neurological deficit needs to last at least 24 hours.
True
When symptoms persist for less than 24 hours it is categorised as a TIA
What are the common causes of ischaemic stroke?
Athrosclerosis
Cardiac embolism (AF, endocarditis, MI)
Chronic hypertension, hypercholesterolaemia, diabetes.
Small vessel occlusion.
Which type of stroke leads to liquefactive necrosis of the brain tissues?
Ischaemic stroke
What are the common diagnostic features of ischaemic stroke?
Visual deficit
Weakness
Aphasia
Dyspraxia
Infarct of which circulation is being described:
- Contralateral paresis and sensory loss in the leg
- Cognitive or personality changes.
A. MCA B. ACA C. PCA D. Lacunar E. TIA
B. ACA
Infarct of which circulation is being described:
- Variable focal neurological deficits lasting <24 hours (most last < 1 hour)
- Often without findings on MRI
A. MCA B. ACA C. PCA D. Lacunar E. TIA
E. TIA
Infarct of which circulation is being described:
- Contralateral paresis and sensory loss in the face and arm
- Gaze preference toward the side of the lesion.
- Nondominant hemisphere—neglect.
- Dominant hemisphere—aphasia.
A. MCA B. ACA C. PCA D. Lacunar E. TIA
A. MCA
CHANGes:
- Contralateral paresis and sensory loss in the face and arm
- Hemiparesis
- Aphasia (dominant)
- Neglect (nondominant)
- Gaze preference toward the side of the lesion
Infarct of which circulation is being described:
- Vertigo
- Homonymous hemianopia
A. MCA B. ACA C. PCA D. Lacunar E. TIA
C. PCA
The 4 Deadly D’s of Posterior Circulation Strokes:
- Diplopia
- Dizziness
- Dysphagia
- Dysarthria
Infarct of which circulation is being described:
Symptoms are pure motor, pure sensory, ataxic hemiparesis, or dysarthria.
A. MCA B. ACA C. PCA D. Lacunar E. TIA
D. Lacunar
What does the stroke campaign acronym ‘FAST’ stand for?
Facial asymmetry
Arm/leg weakness
Speech difficulty
Time (act fast, call 999)
List some differentials for stroke
Head trauma Hypo- or hyper- glycaemia Subdural haemorrhage Intracranial neoplasm Migraine Postictal CNS lymphoma Encephalopathy/Encephalitis Toxoplasmosis Cerebral abscess Infected aneurysm Drug overdose
What investigations would you undertake if you suspected stroke?
Emergent CT head without contrast (check for haemorrhage)
MRI
FBC, PTT, Cardiac enzymes, blood glucose
Identify underlying pathology:
- Cardioembolic (ECG, CXR, echo)
- Thrombotic (carotid doppler, angiography)
How would you manage an ischaemic stroke (if CT confirms no bleed)?
Thrombolysis within 4.5 hours
Endovascular intervention (clot retrieval, shunt)
Antiplatelet
Blood pressure control
True or false: Ischaemic strokes are classified according to the Bamford Stroke Classification.
True
Bamford stroke classification is only used for ischaemic stroke; not haemorrhagic.
According to the Bamford Stroke Classification, what are the different classifications of ischaemic stroke? How are these broadly determined?
4 types:
- Total anterior circulation stroke (TACS)
- Partial anterior circulation stroke (PACS)
- Lacunar syndrome (LacS)
- Posterior circulation syndrome (POCS)
Broadly determined by the focal deficits resulting from the CVA/
Which arteries are involved in a total anterior circulation stroke (TACS)?
Middle and anterior cerebral arteries.
Which deficits need to be present to classify a stroke as a total anterior circulation stroke (TACS)?
All three of the following:
- Unilateral weakness (+/- sensory deficit) of the face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)
Which arteries are involved in a partial anterior circulation stroke (PACS)?
Anterior and middle cerebral arteries, but on part of this circulation has been compromised.
Which deficits need to be present to classify a stroke as a partial anterior circulation stroke (PACS)?
Two of the following:
- Unilateral weakness (+/- sensory deficit) of the face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)
An ischaemic stroke that affects the brainstem would be classified as which type on the Bamford Stroke Classification?
Posterior circulation syndrome (POCS)
An ischaemic stroke that affects the cerebellum would be classified as which type on the Bamford Stroke Classification?
Posterior circulation syndrome (POCS)
Which deficits need to be present to classify a stroke as a posterior circulation syndrome (POCS)?
One of the following need to be present for a diagnosis of POCS:
- Cranial nerve palsy and a contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Conjugate eye movement disorder (e.g. horizontal gaze palsy)
- Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
- Isolated homonymous hemianopia
Which deficits need to be present to classify a stroke as Lacunar syndrome (LACS)?
One of the following needs to be present for a diagnosis of LACS:
- Pure sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic hemiparesis
