P year‎ > ‎Neurology‎ > ‎

12.10.19 Stroke teaching

Classification
  • 20% haemorrhagic
  • 80% ischaemic
    • 80% embolic
    • 20% thrombotic

Risk factors

  • 5 major
    • HTN
    • Smoking
    • Hypercholesterolaemia
    • AF
    • Diabetes
  • Minor
    • Male
    • Old


Location

  • Cortical
    • Can't THINK
  • Subcortical
    • Can't MOVE
    • Often lacunar infarcts
    • Can be much more damaging despite being smaller
      • e.g. internal capsule
  • Anterior
    • Areas supplied by internal carotid
      • i.e. Frontal / Parietal
  • Posterior
    • Areas supplied by vertebral / basilar system
    • i.e. Cerebellum, brainstem, (occipital)


Imaging

  • DWI is very sensitive to ischaemic stroke
  • T2 looks at WATER


Cysticercosis

  • Tissue infection after exposure to eggs of Taenia solium, the pork tapeworm
  • Spread via the fecal-oral route
  • After ingestion the eggs pass through the lumen of the intestine into the tissues and migrate preferentially to the brain and muscles
  • Cysts can persist for years
  • In some cases the cysts will eventually cause an inflammatory reaction presenting as painful nodules in the muscles and seizures when the cysts are located in the brain


Notes

  • Sudden onset
    • 99% occlusion of the ICA can be ASYMPTOMATIC
      • Symptoms only appear when completely blocked
    • Haemorrhage comes out FAST (high pressure)
  • The commonest symptom of a brainstem stroke is still PARALYSIS
    • Use nausea, eye movements etc to distinguish from cerebrum
  • DON'T say haemorrhagic stroke
    • It's a primary intracranial haemorrhage
    • cf haemorrhagic conversion of an ischaemic stroke
  • Stroke symptoms are always negative
    • c.f. Seizures - e.g. Arm rigidity
    • Hypertonia comes later

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