(A&E) (Clinical Imaging) (Cardiovascular) (Medicine of Elderly)

Overview

• An acute neurological condition resulting from a disruption in cerebral perfusion, lasting more than 24 hours
  • Ischaemic Stroke (85%) → cerebral infarction due to insufficient blood flow due to a thrombus or embolus
  • Haemorrhagic Stroke (15%) → cerebral infarction due to haemorrhage (rupture of blood vessel causing leakage of blood into the brain)
• Risk Factors → age >65, hypertension, diabetes, AF, obesity, smoking, high cholesterol

Making Diagnosis

Clinical Features:

• Acute Onset
• MCA (Most Common) → contralateral weakness and sensory loss more marked in the upper limbs and lower half of the face, contralateral homonymous hemianopia, aphasia (broca = expressive, wernicke = receptive)
  • Broca’s (Left Frontal Lobe) ⇒ responsible for speech production (expressive aphasia)
  • Wernicke’s (Left Temporal Lobe) ⇒ responsible for speech comprehension (receptive aphasia)
    • Broca’s = broken speech. Wernicke’s = wer di ficke are you talking about (makes no sense).
• ACA → contralateral weakness and sensory loss more marked in the lower limbs, abulia (behavioural changes), urinary incontinence
• PCA → contralateral homonymous hemianopia with macular sparing, contralateral sensory loss, memory deficits, vertigo, nausea, visual agnosia (difficulty recognising familiar objects/faces)
• Posterior Circulation Stroke → damage to the brainstem. Gives ipsilateral symptoms.
  • DANISH (Cerebellar Signs) ⇒ dysdiadochokinesia, ataxia, nystagmus, intention tremor, slurred speech, hypotonia

Investigations:

• Non-Contrast CT Head → exclude haemorrhage (confirm ischaemic stroke)
  • Normal CT does not rule out an ischaemic stroke
  • PCA Infarct
• CT Angiogram → look for which vessel is occluded
• Look for cause of stroke (after patient has been treated) → Echocardiogram (structural heart disease), Ambulatory ECG (atrial fibrillation), Carotid Doppler (carotid atherosclerosis, if >70% occlusion, carotid endarterectomy recommended)