Ischaemic Stroke Lecture Review

A comprehensive set of vocabulary flashcards covering the definition, classification, risk factors, diagnostic tools, imaging, and management of ischaemic stroke based on BMJ Best Practice guidelines.

World Health Organization Definition of Stroke

A clinical syndrome consisting of rapidly developing clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.

Ischaemic Stroke

Stroke caused by vascular occlusion or stenosis that critically reduces cerebral blood flow.

Haemorrhagic Stroke

Stroke caused by vascular rupture, resulting in intraparenchymal and/or subarachnoid haemorrhage.

Central Venous Sinus Thrombosis

A rare form of stroke that occurs due to thrombosis of the dural venous sinuses.

ROSIER Scale

Recognition of Stroke in the Emergency Room; a validated tool used in the emergency department to aid in the rapid diagnosis of stroke.

FAST

Face Arm Speech Test; a validated screening tool used in the community to identify sudden onset neurological symptoms of stroke.

National Institutes of Health Stroke Scale (NIHSS)

A tool that measures the degree of neurological deficit, where higher scores indicate a more severe stroke.

Trial of Org 10172 in Acute Stroke Treatment (TOAST)

A classification scheme that categorizes ischaemic stroke by pathophysiological mechanisms: large artery atherosclerosis, small vessel occlusion, cardioembolism, other determined aetiology, and indeterminate aetiology.

Large Artery Atherosclerosis

Infarction in the perfusion territory of an extracranial or intracranial artery with $>50\%$ stenosis, where thrombus formation embolises to distal sites.

Small Vessel (Lacunar) Stroke

A stroke caused by thrombotic occlusion of a small penetrating artery affected by lipohyalinosis, resulting in an infarct $<1.5\,\text{cm}$ in diameter.

Lipohyalinosis

Lipid accumulation due to ageing and hypertension that affects small penetrating arteries.

Cardioembolism

Stroke resulting from thrombus formation in the heart, such as from atrial fibrillation, which then embolises to the intracranial circulation.

Bamford (Oxford) Classification

A system that classifies ischaemic stroke based on initial presenting symptoms and clinical signs (Total Anterior, Partial Anterior, Posterior, and Lacunar) without requiring imaging.

Amaurosis Fugax

Transient monocular vision loss that serves as a common early warning signal for cervical carotid stenosis.

Horner's Syndrome

A hemilateral triad consisting of miosis, ptosis, and facial anhidrosis, which may be associated with posterior circulation strokes or carotid artery dissection.

Todd’s Paresis

Postictal focal neurological deficits, such as hemiparesis, following a seizure that can mimic a stroke.

Alteplase

A recombinant tissue plasminogen activator used for intravenous thrombolysis, best initiated within $4.5\,\text{hours}$ of symptom onset.

Tenecteplase

An alternative thrombolytic agent considered safe and effective to alteplase within $4.5\,\text{hours}$ of ischaemic stroke, but not recommended for wake-up strokes without specialized imaging.

Mechanical Thrombectomy

An endovascular procedure to retrieve a clot, performed in selected patients with proximal large vessel occlusion within $6$ to $24\,\text{hours}$ of symptom onset.

DWI-FLAIR Mismatch

A state where an ischaemic lesion is visible on diffusion-weighted MRI but not on fluid-attenuated inversion recovery MRI, indicating the stroke likely occurred within the previous $4.5\,\text{hours}$.

Decompressive Hemicraniectomy

The neurosurgical removal of part of the skull to reduce intracranial pressure, considered for patients with large middle cerebral artery territory infarcts within $48\,\text{hours}$ of onset.

Secondary Prevention Glucose Target

Maintenance of blood glucose concentration between $4\,\text{mmol/L}$ and $11\,\text{mmol/L}$.

Ischaemic Stroke Blood Pressure Threshold (Thrombolysis)

Blood pressure should be reduced to $185/110\,\text{mmHg}$ or lower specifically for patients who are candidates for intravenous thrombolysis.

Atrial Fibrillation (AF)

A cardiac arrhythmia causing at least one fifth of ischaemic strokes and requiring anticoagulation (usually with a DOAC) for secondary prevention.

Moyamoya Disease

Vascular occlusion affecting the circle of Willis, associated with sickle cell disease.

Wernicke's Encephalopathy

A stroke mimic presenting with irritability, confusion, and delirium, associated with alcohol abuse and decreased blood thiamine levels.

ASPECTS

Alberta Stroke Program Early Computed Tomography Score; used to determine eligibility for mechanical thrombectomy between $6$ and $24\,\text{hours}$.

Dual Antiplatelet Therapy (DAPT)

The combination of aspirin with clopidogrel (for $21\,\text{days}$) or aspirin with ticagrelor (for $30\,\text{days}$) used for minor ischaemic stroke ($\text{NIHSS} \le 3$).