Stroke

Question 1

What are the 4 key typical stroke syndrome features?

Answer 1

• Sudden Onset
• Focal
• Predominately Negative
• Vascular territory hypo perfusion can explain collection of symptoms
• Symptoms do not typically migrate
• Episodes do not typically stereotype

Question 2

What is Capsular Warning Syndrome ?

Answer 2

• Hypoperfusion in the capsular region of the brain known as the striatum
• gives lacunar symptoms of stroke
• give symptoms crowding in a period of time e.g. three times a day
• fluctuating of symptoms not complete resolution

Question 3

What is Intracranial Stenosis?

Answer 3

• Can causes a global hypoperfusion, especially when standing up (postural hypotension)
• every time standing up the weakness on the right sight
• however not a stroke mimic as has evidence of global hypoperfusion such as going pale, dizzy when standing up

Question 4

What are Stroke Mimics?

Answer 4

• Seizures
• Hypoglycaemia
• Hyponatraemia
• Bell’s Palsy
• Migraine with Aura
• Functional Syndrome
• Apparent neurological deficits (

Question 5

What are the Groups of Stroke Mimics ?

Answer 5

• Group 1 - identifiable on Brian imaging ( subdural haematoma, brain abscess, meningoma)
  MS - MRI scan
  CT with contrast - brain abscess, brain tumour
• Stage 2 - syndromically distinguishable from the stroke syndrome on clinical grounds
• Stage 3 - specialist stroke assessment including brain imaging

Question 6

What is the definition of Sterotyping ?

Answer 6

• episodic recurrence in a identical fashion
• complete resolution in between episodes

Question 7

Transient global amnesia?

Answer 7

• Acute confusion
• no recollection of events
• asks the same questions
• no signs of focal involvement
• completely resolved within 2 hours
• Neurological examination normal
• Affects the Episodic Memory - Memory of events
• Recurrance is unlikely

Question 8

Transient epileptic amnesia?

Answer 8

• recurrent episodes of recurrent amnesia
• ## stroke mimic

Question 9

What is Migraine with Aura?

Answer 9

• Cortico spreading depression
• wave of depolarisation of neuronal activity that spreads across the brain
• Migraine comes in gradually
• slowly spreading of the symptoms - from hand to arm, followed by visual disturbance
• stroke mimic

Question 10

What is the stroke aetiology ?

Answer 10

• type of parenchymal damage ( haemorrhagic/ Ischaemic)
• Mechanism causing hypoperfusion ( embolism/ thrombosis/ vasoconstriction in PCA)
• Disease/ Pathology process primarily responsible for mechanism of hypoperfusion ( atrial fibrillation/ anti-phospholipid syndrome/ vertebral dissection/ carotid disease )

Question 11

What are post-stroke complications ?

Answer 11

• recurrent stroke
• complications of immobility (bed sores, VTE)
• Raised ICP ( malignant oedema, hydrocephalus)
• Infections
• Mood and cognitive symptoms
• Post stroke fatigue
• Post stroke pain
• Spasticity & contractures, secondary epilepsy

Question 12

How can you manage the complications of the stroke ?

Answer 12

• anticipation of complications
• daily obs, mood, chest, legs, bowel and urine function, progress of impairments
• timely bloods - infection

Question 13

What is the Stroke Care bundle?

Answer 13

• Admission to stroke unit
• Reperfusion therapy
• Nutritional support
• Secondary Prevention
• Rehabilitation
• Optimising physiology and surveillance, prevention and early intervention of complications