Stroke Differential Diagnosis
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Questions and Answers

What is a characteristic symptom of a stroke that affects one side of the body?

  • Hemorrhage and seizures
  • Confusion and transient loss of consciousness
  • Global neurological dysfunction
  • Unilateral weakness of the face, arm, and leg (correct)

    • What is the primary basis for the Bamford classification system for ischemic stroke?

  • Radiographical imaging
  • Presenting symptoms and clinical signs (correct)
  • Location of the brain affected
  • Age and medical history of the patient

    • What distinguishes a total anterior circulation stroke (TACS) from a partial anterior circulation stroke (PACS)?

  • Duration of the stroke
  • Location of the brain affected
  • Age of the patient
  • Severity of the stroke (correct)

    • What is a characteristic feature of global neurological dysfunction?

    <p>Confusion and transient loss of consciousness</p> Signup and view all the answers

    What is a condition that may mimic a stroke?

    <p>Migraine</p> Signup and view all the answers

    What are the three requirements for a diagnosis of total anterior circulation stroke (TACS)?

    <p>Unilateral weakness, homonymous hemianopia, and higher cerebral dysfunction</p> Signup and view all the answers

    What is the minimum number of symptoms required for a diagnosis of PACS?

    <p>Two</p> Signup and view all the answers

    Which of the following is NOT a symptom of POCS?

    <p>Dysphasia</p> Signup and view all the answers

    What is the primary characteristic of a lacunar stroke?

    <p>Blockage of a small artery deep in the brain</p> Signup and view all the answers

    What is the term for a stroke that involves the middle cerebral artery?

    <p>Middle cerebral artery stroke</p> Signup and view all the answers

    What is the purpose of the ABCD2 score?

    <p>To estimate the risk of stroke following a TIA</p> Signup and view all the answers

    What percentage of stroke cases are hemorrhagic strokes?

    <p>13%</p> Signup and view all the answers

    What is the term for a sudden loss of brain function?

    <p>Stroke</p> Signup and view all the answers

    What is the term for a temporary loss of brain function?

    <p>TIA</p> Signup and view all the answers

    What is the term for a blockage of a small artery deep in the brain?

    <p>Lacunar stroke</p> Signup and view all the answers

    What is the term for a stroke that involves the posterior circulation?

    <p>POCS</p> Signup and view all the answers

    What is the condition in which amyloid proteins build up on the walls of the arteries in the brain?

    <p>Cerebral Amyloid Angiopathy (CAA)</p> Signup and view all the answers

    What is the term for a bulge in a blood vessel caused by a weakness in the blood vessel wall?

    <p>Aneurysm</p> Signup and view all the answers

    What is the type of hemorrhagic stroke that occurs when a blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and the skull?

    <p>Subarachnoid Hemorrhage</p> Signup and view all the answers

    What is the term for an abnormal tangle of blood vessels connecting arteries and veins that can disrupt normal blood flow and oxygen circulation?

    <p>Arteriovenous Malformation (AVM)</p> Signup and view all the answers

    What is the term for bleeding into the tissue deep within the brain?

    <p>Intracerebral Hemorrhage</p> Signup and view all the answers

    What is the imaging test commonly used to diagnose hemorrhagic stroke?

    <p>CT scan</p> Signup and view all the answers

    What is the term for a procedure where a tiny clamp is placed at the base of an aneurysm to halt blood flow to it?

    <p>Surgical Clipping</p> Signup and view all the answers

    What is the term for a procedure where tiny detachable coils are inserted into the aneurysm using a catheter?

    <p>Embolization</p> Signup and view all the answers

    What is the term for the removal of an AVM surgically?

    <p>Surgical AVM Removal</p> Signup and view all the answers

    What is the time window for IV thrombolysis or endovascular thrombectomy in acute ischemic stroke?

    <p>30 minutes after arrival in hospital</p> Signup and view all the answers

    What is a necessary condition for initiating thrombolysis in a patient with ischemic stroke symptoms?

    <p>The patient's symptoms must be disabling and persist after glucose normalization.</p> Signup and view all the answers

    What is a contraindication for IV thrombolysis in acute ischemic stroke?

    <p>Gastrointestinal or genitourinary bleeding within the last 21 days.</p> Signup and view all the answers

    What is the recommended time frame for initiating thrombolysis treatment?

    <p>Within 4.5 hours of last known well time.</p> Signup and view all the answers

    What is the recommended next step if a patient's stroke symptoms persist after glucose normalization?

    <p>Treat with IV alteplase.</p> Signup and view all the answers

    What is the primary agent used for thrombolysis in acute ischemic stroke?

    <p>Alteplase.</p> Signup and view all the answers

    What is a consideration for exclusion from thrombolysis?

    <p>Recent major surgery or major trauma.</p> Signup and view all the answers

    What is the recommended procedure for removing a thrombus under image guidance?

    <p>Thrombectomy.</p> Signup and view all the answers

    What is a consideration for thrombolysis between 4.5 and 9 hours?

    <p>CT/MR perfusion findings are favorable with a small core and large penumbra.</p> Signup and view all the answers

    What is a contraindication for IV thrombolysis if a patient has taken a novel oral anticoagulant (DOAC)?

    <p>Within the last 48 hours.</p> Signup and view all the answers

    What is the recommended approach if a patient has a wake-up stroke or unknown time of onset?

    <p>Neurology consultation with advanced imaging.</p> Signup and view all the answers

    What is the primary goal of emergency treatment for hemorrhagic stroke?

    <p>Controlling the bleeding and reducing pressure in the brain</p> Signup and view all the answers

    What is the recommended time window for deciding on IV thrombolysis or endovascular thrombectomy?

    <p>Within 30 minutes of arrival in hospital</p> Signup and view all the answers

    What is the minimum age requirement for IV thrombolysis treatment?

    <p>≥ 18 years</p> Signup and view all the answers

    What is the primary benefit of administering IV tPA in acute ischemic stroke?

    <p>Improving the patient's neurological outcomes</p> Signup and view all the answers

    What is the recommended time for follow-up CT brain after thrombolysis or thrombectomy?

    <p>At 24 hours after the procedure</p> Signup and view all the answers

    What is the primary goal of stroke unit care?

    <p>Producing the best outcomes following thrombolysis or thrombectomy</p> Signup and view all the answers

    What is the primary mechanism of action of thrombolytic agents in acute ischemic stroke?

    <p>Breaking down blood clots in the brain</p> Signup and view all the answers

    What is the primary complication of immobility in stroke patients?

    <p>Pressure injuries</p> Signup and view all the answers

    What is the primary goal of aspirin administration after thrombolysis or thrombectomy?

    <p>Preventing further ischemic strokes</p> Signup and view all the answers

    What is the primary method of blood clot removal in thrombectomy?

    <p>Mechanical breakdown of the clot</p> Signup and view all the answers

    Study Notes

    Stroke Diagnosis and Classification

    • Stroke presents with abrupt onset, focal neurological signs, and symptoms, often affecting one side of the body. • The Bamford classification system is commonly used to classify ischemic stroke into: + Total Anterior Circulation Stroke (TACS) + Partial Anterior Circulation Stroke (PACS) + Posterior Circulation Syndrome (POCS) + Lacunar Stroke (LACS) • Each type of stroke has specific diagnostic criteria, including symptoms and signs.

    Conditions that Mimic Stroke

    • Transient Ischemic Attack (TIA) • Seizure • Migraine • Hypoglycemia • Hypotension • Brain neoplasm • CNS infections • Each of these conditions has distinct characteristics and features that can help distinguish them from stroke.

    Hemorrhagic Stroke

    • Accounts for about 13% of stroke cases • Caused by a weakened vessel that ruptures and bleeds into the surrounding brain • The most common causes of hemorrhagic stroke are: + Hypertension + Cerebral Amyloid Angiopathy (CAA) + Aneurysm + Arteriovenous Malformation (AVM) • Emergency treatment focuses on controlling bleeding and reducing pressure in the brain.

    Treatment Options for Acute Ischemic Stroke

    • Thrombolysis • Thrombectomy • The care team should decide if IV thrombolysis or endovascular thrombectomy is indicated within 30 minutes after arrival in hospital. • IV thrombolysis treatment should be implemented provided that: + Treatment can be initiated within 4.5 hours of last known well time (LKWT) + Patient is ≥ 18 years + No exclusion criteria are present • Tissue plasminogen activator (tPA) is the thrombolytic agent used to break down blood clots.

    Post-Stroke Complications

    • Delirium • Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) • Pneumonia • Infections • Aspiration • Bowel/bladder dysfunction • Myocardial infarction • Heart failure • Pressure injuries • Depression • Pain • These complications can arise following a stroke, and healthcare professionals must seek to prevent them and detect them early to initiate treatment.

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    Description

    This quiz helps identify conditions that mimic stroke symptoms, including seizures, migraines, hypoglycemia, and brain neoplasms. Learn to differentiate stroke from other causes of focal neurological signs and symptoms.

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