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