🎓
Stroke
Neurology
Weakness
Speech disturbance
Visual loss
Stroke is a neurological deficit caused by an acute focal injury to the central nervous system by a vascular cause (ischaemic or haemorrhagic). Rapid assessment is vital for reperfusion therapies.
🎯 Key Learning Objectives
- Classify stroke using the Bamford (Oxford) criteria.
- Differentiate ischaemic (85%) from haemorrhagic (15%) stroke via CT.
- Assess eligibility for Thrombolysis (within 4.5h) and Thrombectomy (within 6-24h).
- Initiate secondary prevention (Antiplatelets, Statins, Anticoagulation for AF).
- Identify and manage Transient Ischaemic Attack (TIA) based on NIHSS and risk.
- Collaborate with the multidisciplinary team for rehabilitation.
🔬 Pathophysiology
Ischaemic stroke: Thromboembolism or in-situ thrombosis occludes a cerebral artery, causing an infarct core and a salvageable 'penumbra'. Haemorrhagic stroke: Rupture of a blood vessel leading to intracerebral or subarachnoid bleeding.
🩺 Clinical Features
Symptoms
- Sudden onset unilateral weakness
- Facial droop
- Dysphasia
- Ataxia
- Visual field defects
Signs
- FAST positive
- Hyper-reflexia
- Extensor plantar response (Babinski)
- Homonymous hemianopia
🔬 Investigations
🛏️ Bedside
- Blood glucose (must exclude hypoglycaemia)
- ECG (exclude AF)
- NIHSS score
🩸 Bloods
- Coagulation screen
- FBC
- U&Es
- Lipids
📷 Imaging
- Non-contrast CT Head (urgent to exclude bleed)
- CT Angiogram (for thrombectomy)
- MRI Brain (DWI)
⚗️ Special
- Carotid Doppler
- Echocardiogram
💊 Management
🚨 Acute Management
- Alteplase (thrombolysis) if <4.5h
- Aspirin 300mg (after bleed excluded)
- Mechanical thrombectomy
- Blood pressure control (labetalol) if very high
📋 Long-Term
- Clopidogrel 75mg daily
- Atorvastatin 80mg
- Antihypertensives
- Anticoagulation for AF (after 2 weeks)
🏃 Lifestyle
- Smoking cessation
- Alcohol reduction
- Salt reduction
- DVLA notification (no driving for 1 month)
⚠️ Complications
Cerebral oedema
Aspiration pneumonia
Post-stroke depression
Seizures
Shoulder subluxation
⭐ High-Yield Pearls
- A TACS (Total Anterior Circulation Stroke) requires: Hemiparesis, Hemianopia, and Higher cortical dysfunction.
- Hiccups or altered taste can occur in Lateral Medullary Syndrome (Wallenberg).
- Blood pressure should not be lowered acutely in ischaemic stroke unless >220/120.
- The 'time is brain' window for thrombolysis is 4.5 hours.
- Aspirin 300mg should be given for 14 days following an ischaemic stroke before switching to Clopidogrel.
📖 GUIDELINES:
NICE NG128
RCP National Clinical Guideline for Stroke
❓ Practice Questions
Q1. A 24-year-old woman presents with a 4-hour history of a severe, throbbing unilateral headache accompanied by sensitivity to light and nausea. She has experience…
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Q2. A 45-year-old man is brought to the Emergency Department by ambulance while undergoing a generalized tonic-clonic seizure. The paramedics report the seizure sta…
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Q3. A 31-year-old woman presents with a 3-day history of blurred vision in her left eye and pain on eye movement. On examination, there is a left-sided afferent pup…
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