Apoplexy

• The first common term for stroke in Greek literally meant “struck suddenly with violence”

• The term stroke refers to being suddenly stricken

Types of stroke

• Ischaemic• Haemorrhagic• Transient Cerebral Ischaemic Attak

Transient Ischaemic Attacks (TIA)

• “A clinical syndrome characterized by an acute loss of focal cerebral or monocular function

with symptoms lasting less than 24 hours and which is thought to be due to inadequate cerebral or ocular blood supply as a result of low blood flow, arterial thrombosis or embolism associated with disease of arteries, heart or blood” – Hankey & Warlow 1994

• First described by Miller Fisher in 1953• Usually due to micro emboli

Pathology

• Mechanisms of cerebrovascular damage to brain tissue:

• Two major categories –

• 1. Ischaemia – a lack of blood flow depriving brain tissue of needed fuel and oxygen.

• 2. Haemorrhage – the release of blood into the brain and into extravascular spaces within the cranium.

Ischaemia

• Ischaemia – subdivided into three different categories:

• 1. Thrombosis• 2. Embolism• 3. Decreased systemic perfusion

Haemorrhage

• Two types:• 1. Subarachnoid haemorrhage• 2. Intracerebral haemorrhage (Primary

Intra Cerebral Haemorrhage- PICH)

Risk factors

• Smoking• Hypertension• Hyperlipidemia• Overweight/obesity• Diabetes mellitus• Family history of stroke or heart diseases• Cardiac arrhythmias• Bleeding diathesis• Regular heavy drinking• Drug abuse - cocaine

ABCD2 score

TACS/ PACS

Total/ partial anterior circulation strokes

TACS = Most of the following +/- Death Higher Dysfunctions (cognitive, emotional and also things like conscious control of defaecation and micturition)DysphasiasVisuospatial problemsHomonymous HemianopiaMotor/Sensory Deficits

Partial Anterior Circulation InfarctAny of following symptoms:

2/3 Similar to TACIPartial motor/sensory deficitsHigher dysfunction alone

LACS – lacunar infarcts

Small, subcortical strokes, due to small vessel disease, no evidence of higher cerebral dysfunction – result from the occlusion of penetrating arteries

PURE MOTOR/ SENSORY/ SENSORI-MOTOR LOSS ATAXIC HEMIPARESIS

POCS – POSTERIROR CIRCULATION INFARCTS

Posterior cerebral arteryVertebrobasillar circulation

Cranial nerve palsy & contralateral motor/sensory deficitBilateral motor or sensory deficitCerebellar signsEye Movement deficits/isolated homonymous hemianopia

COGNITIVE ASSESSMENT Cognition = the mental act or process by which knowledge is acquired, including perception, intuition and reasoning

How do we aquire knowledge?

We need a set of tool for doing so and a method of keeping the knowledge in out brains

Memory -anterograde- retrograde- Working

Reading

Writing

Attention

Calculation

Language

Visuospatial

Executive function

AMT -10

MEMORY – RETROGRADE ATTENTION?MEMORY ANTEROGRADEATTENTION/ MEMORY RGMEMORYEXECUTIVE FUNCTION?MEMORY RETORGRADE MEMORY RETORGRADE MEMORY RETORGRADE MEMORY RETORGRADE EXCUTIVE FUNCTION/ CALCULATION

+ FOR ALL OF IT – LANGUAGE WILL BE SUBJECTIVELY TESTABLEAS WILL PRAXIA – FOR ARTICULATION SPEECH MOVEMENT

MMSE

Supplies

Red = MCATurquoise = ACASky blue = PCA

The Circle of Willis

History – SPLATT!

• Symptoms: dizziness, lightheaded, chest pain, palpitations, loss of consciousness, tongue biting

• Previous falls: is this the first fall? Or one of many?• Location: where did the fall happen?• Activity: what were you doing when you fell?• Time: was it soon after taking tablets, or after meal,

associated with coughing / straining?• Trauma sustained? Any injuries that need

attention?

+ Drug History

DAME – common causes of falls

• Drugs: polypharmacy, alcohol

• Age-related changes: gait, balance, sarcopenia, sensory impairment

• Medical: syncope, Parkinson’s disease, stroke

• Environmental: obstacles, trailing wires, lighting