Stroke

Question 1

What are the 2 types of stroke?

Answer 1

• Ischaemic
• Haemorrhagic

Question 2

What are risk factors for ischaemic stroke?

Answer 2

• Age
• HTN
• Smoking
• Hyperlipidaemia
• DM
• AF

Question 3

What are the risk factors of haemorrhagic stroke?

Answer 3

• Age
• HTN
• AV malformation
• Anticoagulation therapy

Question 4

What is the Bamford/Oxford Stroke classification for TACI?

Answer 4

Total anterior circulation: MCA, ACA
- Unilateral hemiparesis/hemisensory loss of the face, arm and leg
- Homonymous hemianopia
- Higher cognitive dysfunction e.g. dysphasia

Question 5

What is the bamford classification for PACI?

Answer 5

Partial: involving the smaller arteries
2 of the following:
- Unilateral hemiparesis/hemisensory loss of the face, arm and leg
- Homonymous hemianopia
- Higher cognitive dysfunction e.g. dysphasia

Question 6

What is the bamford classification for lacunar infarct?

Answer 6

• involves perforating arteries around the internal capsule, thalamus and basal ganglia
• presents with 1 of the following:
  1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
  2. pure sensory stroke.
  3. ataxic hemiparesis

Question 7

What is the bamford classification for POCI?

Answer 7

• involves vertebrobasilar arteries
• presents with 1 of the following:
  1. cerebellar or brainstem syndromes
  2. loss of consciousness
  3. isolated homonymous hemianopia

Question 8

What are the common symptoms of haemorrhagic stroke?

Answer 8

• Decrease in consciousness
• Headache
• N+V
• Seizures

Question 9

What is the tool used to recognise stroke in A+E?

Answer 9

ROSIER

Question 10

How is stroke managed?

Answer 10

• Exclude hypoglycaemia
• CT brain
• 300mg aspirin once haemorrhage excluded for 2 weeks
• Thrombolysis with alteplase can be used if within 4.5 hours of onset
• Thrombectomy can be used for strokes in proximal anterior/posterior circulation within 24 hours of symptoms

Question 11

What is the long term management of stroke?

Answer 11

• Assess for underlying cause e.g. cartoid imaging, ECG and intervene where possible
• Clopidogrel 75mg once daily
• Atorvastatin started after 48 hours
• Control BP and Diabetes
• Control modifiable risk factors
• Rehab