1 / 30

HOW CAN I BE SURE THIS IS A STROKE ? DR. INDIRA NATARAJAN LOCUM CONSULTANT UNIVERSITY HOSPITAL OF NORTH STAFFRODSH

HOW CAN I BE SURE THIS IS A STROKE ? DR. INDIRA NATARAJAN LOCUM CONSULTANT UNIVERSITY HOSPITAL OF NORTH STAFFRODSHIRE. WHO DEFINITION.

beck
Download Presentation

HOW CAN I BE SURE THIS IS A STROKE ? DR. INDIRA NATARAJAN LOCUM CONSULTANT UNIVERSITY HOSPITAL OF NORTH STAFFRODSH

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HOW CAN I BE SURE THIS IS A STROKE ? • DR. INDIRA NATARAJAN LOCUM CONSULTANT UNIVERSITY HOSPITAL OF NORTH STAFFRODSHIRE

  2. WHO DEFINITION “ rapidly developing clinical signs (at times global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin” This definition includes signs and symptoms of suggestive of - ischaemic stroke - haemorrhages (intracerebral or subarachanoid)

  3. IS THIS A STROKE? History - sudden onset of focal symptoms, risk factors for stroke, relevant past medical history Examination - neurological signs consistent with story

  4. Diagnostic Dilemma • “ Stroke Mimics ” or “ Stroke Syndrome ” • 10% - 15% of patients referred with possible stroke have something else • Some uncertainty is inevitable

  5. How to approach? • Focus on the event • Onset whether sudden or gradual • Try to get the sequence of events • Previously fit and well • Preceding illness • Similar episodes • Risk factors

  6. Pattern Recognition • FACE • SPEECH • ARM • LEG

  7. Stop and Think! • Drowsy and Delirious • Patient with headache • Drowsiness, confusion and headache

  8. Drowsiness /Delirium • SEIZURES • METABOLIC / TOXIC • SUBDURAL HAEMATOMA

  9. Seizures • Commonest cause of misdiagnosis • Eye witness • Look for Ictal features – loss of consciousness, convulsion, incontinence, tongue biting • Post Ictal features – sleepiness and confusion

  10. METABOLIC • Hypoglycaemia • Alcohol and drugs • Hyponatraemia • Hypocalcaemia • Hepatic encephalopathy • Wernick-Korsakoff syndrome • Hyperglycaemia

  11. Subdural Haematoma • Usually in the elderly • Recurrent fallers • If significant will cause drowsiness • Sometimes headache, confusion, hemiplegia or dysphasia • Features may fluctuate • Diagnosis : CT scan

  12. Headache • VENOUS THROMBOSIS • MIGRAINE • CEREBRAL VASCULITIS • ARTERIAL DISSECTION

  13. Venous Thrombosis • Most have headache • Half have raised ICP • Some have neurological signs • Prothrombotic state • D - Dimer • CSF if often abnormal – high protein and raised pressure • MR or CT venography diagnostic

  14. Migraine • Visual aura • Visual phenomenon • Sensory symptoms • Dysphasia can occur • Headache

  15. Cerebral Vasculitis • Unwell prior to the event • Look for clues • Results in infarcts or bleeds • ESR can be raised • MRI and CSF abnormal • Check auto antibodies

  16. Arterial Dissection • History of Neck Trauma • Pain - Face and around eye • Unilateral Headache • Unilateral Neck pain – Carotid artery • Occipital pain – Vertebral artery • Ipsilateral Horner’s Syndrome • Ipsilateral Cranial nerve lesion and contralateral pyramidal tract lesion • CT MAY BE NORMAL – DISCUSS WITH RADIOLOGIST

  17. HEADACHE AND DROWSINESS • CEREBRAL TUMOUR • ENCEPHALITIS • CEREBRAL ABSCESS

  18. Cerebral Tumours • Onset is slower than stroke • Signs of Raised ICP – headache, vomiting, drowsiness, papilloedema • CT Scan confirms diagnosis • Sometimes further imaging needed

  19. Encephalitis • Usually fit and well • Acute Confusional State • Mild preceding febrile illness, headache and drowsiness • Sometimes fits, and gradual onset coma • 15% of patients have focal signs • CT scan usually normal • CSF usually abnormal

  20. Cerebral Abscess • Subacute onset • Usually spread from sinuses or ear • Headache usual • Signs of sepsis • Later drowsiness, vomiting, delirium • Dysphasia, visual field defects and facial weakness more common • Avoid LP • CT Scan

  21. ALSO LOOK OUT FOR ATYPICAL CLINICAL PRESENTATIONS

  22. Transient Global amnesia • Middle aged or elderly people • Sudden onset • Loss of memory for a period of time • No loss of personal identity • May have headache • Good recovery

  23. Old Stroke with increased weakness • Old neurological signs often worse during intercurrent illness • Rapid return to previous level of function is usual with appropriate treatment

  24. Syncopal episodes • Loss of consciousness • Light headedness with diminishing loss of vision

  25. Hysteria / Functional • Young patient • Focal neurology not fitting with examination • Similar events in the past • Mental health issues • Hyperventilation

  26. FACIAL PALSY • Bell’s Palsy • Low NIHSS score

  27. To Summarise….. • Sudden onset • Risk factors for vascular event • Clear pattern of weakness It is a Stroke

  28. Features prompting caution…. • Atypical pattern of weakness • Drowsy/ Delirium • Headache • Pyrexia • Malaise or prodromal illness • Gradual progression over days • Features of raised ICP • Young age or absence of risk factors

  29. THE EYES DO NOT SEE WHAT THE MIND DOES NOT KNOW

  30. THANK YOU

More Related