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