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MRCP neurology notes (source: passmedicine)
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MRCP neurology notes with source from passmedicine.
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MRCP NEUROLOGY NOTESStroke
Stroke by anatomy
The Oxford Stroke Classification (also known as the Bamford Classification) classifies strokes based on the initial symptoms.
The following criteria should be assessed:
1. Unilateral hemiparesis and/or hemisensory loss of the face, arm & leg.
2. Homonymous hemianopia
3. Higher cognitive dysfunction e.g. dysphasia
Total anterior circulation infarcts (TACI, c. 15%)
• Involves middle & anterior cerebral arteries.
• All 3 of the above criteria are present.
Partial anterior circulation infarcts (PACI, c. 25%)
• Involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery.
• 2 of the above criteria are present
Lacunar infarcts (LACI, c. 25%)
• Involves perforating arteries around the internal capsule, thalamus & basal ganglia.
• Presents with 1 of the following:
. Unilateral weakness (and/or sensory deficit) of face & arm, arm & leg or all three
i. Pure sensory stroke
ii. Ataxic hemiparesis
Posterior circulation infarcts (POCI, c. 25%)
• Involves vertebrobasilar arteries
• Presents with 1 of the following:
. Cerebellar or brainstem syndromes
i. Loss of consciousness
, ii. Isolated homonymous hemianopia
Other recognised patterns of stroke:
a. Lateral medullary syndrome (PICA)
• Aka Wallenberg's syndrome
• Ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner's
• Contralateral: limb sensory loss
b. Weber's syndrome
• Ipsilateral III palsy
• Contralateral weakness
Lateral medullary syndrome
Also known as Wallenberg's syndrome, occurs following occlusion of the posterior inferior cerebellar artery.
Cerebellar features
• Ataxia
• Nystagmus
Brainstem features
• Ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner's
• Contralateral: limb sensory loss
, Stroke: assessment
The FAST screening tool (Face/Arms/Speech/Time) is widely known by the general public following a publicity campaign. It has a positive predictive value of
78%.
A variant of FAST called the ROSIER score is useful for medical professionals. It is validated tool recommended by the Royal College of Physicians.
Investigations: A non-contrast CT head scan is the 1st line for suspected stroke.
, Stroke management
Nice guidelines (2019)
Selected points relating to the management of acute stroke include:
• Blood glucose, hydration, oxygen saturation and temperature should be maintained within normal limits.
• BP should not be lowered in the acute phase unless there are complications e.g. Hypertensive encephalopathy.
• Aspirin 300 mg orally or rectally should be given as soon as possible if a haemorrhagic stroke has been excluded.
• With regards to AF, the Royal College of Physician (RCP) state: anticoagulant should not be started until brain imaging has excluded haemorrhage,
and usually not until 14 days have passed from the onset of an ischaemic stroke.
• If the cholesterol is > 3.5 mmol/l pt should be commenced on a statin. Many physicians will delay treatment until after at least 48 hrs d/t risk of
haemorrhagic transformation.
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