STROKE

1. Definition of stroke and tia
2. Classification 
3. history and examination
4. Differential
5. Complication
6. Investigation
7. Management (emergency, specific, supportive, rehabilitation, secondary prevention)

1. Definition of stroke and tia. 

Stroke: Sudden onset of focal/global neurological deficit lasting >24hr.

TIA: transiet lasting less than one hour.

2. Classification

Oxfordshire community stroke project classification (OCSP)

• Total anterior circulation stroke 
• Partial anterior circulation stroke
• Posterior circulation stroke 
• lacunar stroke

Aetiology

1. Haemorrhage

• Hypertension
• Bleeding disorder
• AV malformation
• Budd-chiary microanuerysm

2. Ischeamic

• atherosclerosis
• emboli (eg: cardiac emboli, hypotension)

3. history and examination

- Ask about neurological deficit.

- Ask abour primary diasease.

- Ask about cardivascular RF.

- complication 

- sign depends in the site where it happen ( cortical vs lacunar), ant, post and middle.

Anterior cerebral artery

• more leg than arm
• behavior changes

Posterior cerebral artery

• cortical blindness
• cerebellar sign
• hemianopia
• cranial nerve palsy
• spinal tract problem
• horner syndrome

middle cerebral artery

• facial weakness
• body and arm
• receptive dysphasia 
• hemosensory loss
• hemineglect

lacunar

• dense hemiplegia ( pure motor)
• loss sensory (numbness without weakness)(pure  sensory)

4. Differentials

• mass lesion: tumour, abcess, haematoma.
• metabolic derangement : glucose, electrolyte
• unique : migrane and fit
• psychogenic

5. Complication.

early

• immobility (DVT, bed sore, pneumonia)
• UTI

late

• dev contracture
• seizure/epilepsy
• psychological effects
• dependency
• death

6. Investigation 

Blood 

• FBC,                                              optional : VDRL, autoimmune screen, thrombophilia and 
• RBS                                                                 lupus anti- coagulant, homocystiene and CRP
• Renal Profile
• Coagulation profile
• Lipid profile
  

imaging 

• CT-brain                                          * MRA, echo, carotid duplex US
• 12 lead ECG
• CXR

7. Management

• correct diagnosis
• resuscitation
• acute treatment ( recanalise with thrombolytic eg rtPA, angioplasty+stent)
• neuronal protection (BP, glucose, sepsis, nutritionm hydration)
• rehabilitation ( physio, speech and occupational tx)
• secondary prevention : antiplatelet (eg aspirin, clopidogrel), BP, DM, lipids, endarterectomy)
• consel/support/patient/ education with pt and family member.

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