define stroke
the rapid permanent neurological deficit from cerebrovascular insult. Also defined clinically, as focal or global impairment of CNS function developing rapidly and lasting > 24 hrs
how can a stroke be subdivided?
- either by infarction or haemorrhage
- or by position so anterior circulation or posterior circulation
what is a TIA?
- a TIA is lasting less than 24 hours
- a stroke lasts longer than 24 hours
what can ischaemic strokes be caused by?
- thrombosis
- emboli
- hypotension
- vasculitis
- cocaine
what types of haemorrhage are there?
- intracerebral
- subarachnoid
presenting symptoms of a stroke?
- sudden onset
- unilateral hemiparesis
- motor weakness
- visual field defects
- impaired coordination
- impaired consciousness
- swallowing problems
how does an anterior cerebral artery present?
- contralateral hemiparesis
and sensory loss - lower extremity > upper
how does a middle cerebral artery present?
contralateral hemiparesis and sensory loss
- upper extremity>lower extremity
- Contralateral homonymous hemianopia
- aphasia
how does a posterior cerebral artery present?
- contralateral homonymous hemianopia with macular sparing
- visual agnosia
how does posterior cerebral artery present?
- ipsilateral CN III palsy
- contralateral weakness of upper and lower extremities
how does the posterior inferior cerebellar artery present?
- Ipsilateral: facial pain and temperature loss
- contralateral limb/torso pain and temperature loss
- ataxia
- nystagmus
how does anterior inferior cerebellar artery present?
- similar to PICA
- difference is ipsilateral facial paralysis and deafness
how does the ophthalmic artery present?
- Amaurosis fugax
sudden blindness
how does the basilar artery present?
- presents with locked in syndrome
how do lacunar strokes present?
- isolated hemiparesis
- hemisensory loss
- limb ataxia
- strong association with hypertension
what are the investigations for stroke?
1. CT head scan Differentiates between haemorrhages and infarction 2. MRI brain 3. Bloods 4. ECG 5. Echo 6. Carotid doppler USS 7. CT cerebral angiogram
how to manage a hyper-acute stroke?
- if less than 4.5 hours from
- exclude haemorrhage using urgent imaging
- if the haemorrhage has been excluded then thrombolysis is offered.
how to manage acute ischaemic stroke?
- Aspirin + Clopidogrel
- Heparin
- GCS monitorring
- Thromboprophylaxis
how to manage a TIA?
- immediate aspirin 300mg
- more than one TIA discuss the need for urgent admission to stroke unit
- if patient has had suspected TIA in the last 7 days they need urgent assessment by physician.
how to manage a haemorrhagic stroke?
- referral to neurosurgical consultation required
- anticoagulants and antithrombotics should be stopped
- blood pressure should be lowered
what are the complications of strokes?
- Cerebral oedema
- immobility
- infections
- DVT
- cardiovascular events
- death
what is the prognosis for patients with stroke?
- 10% mortality in the first month
- up to 50% of those who survive will be dependent upon others
- there is a 10% reoccurrence in one year
- the prognosis for hemorrhage is worse than ischemia
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Myasthenia Gravis17
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Stroke22
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Hydrocephalus10
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Bells Palsy9
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Epilepsy25
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Horners Syndrome9
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Migraine12
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Subarachnoid haemorrhage13
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Subdural Haemorrhage14
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Tension headache10
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TIA19
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Meningitis?26
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cluster headache5
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encephalitis9
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Guillian-barre syndrome12
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Huntingtons7
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Motor Neuron disease13
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Multiple Sclerosis17
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neurofibromatosis9
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Parkinsons disease11
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spinal cord compression12
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trigeminal neuralgia7
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Wernickes encephalopathy8
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CNS tumours9
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spinal radiculopathy5
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raised ICP?8
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extradural haemorrhage8
