24 - Stroke

Question 1

Other name for stroke

Answer 1

Cerebro-vascular accident (CVA)

Question 2

Cerebro-vascular accident

Answer 2

A focal neurological deficit that persists for >24hr and is due to a vascular cause

Question 3

Pathophysiology of CVA

Answer 3

• Narrowing or blockage of blood vessels supplying the brain (Thrombus/embolus)
• Rupture of a vessel (hypertension or aneurysm) with haemorrhage

Question 4

Brain ischemia

Answer 4

• The brain highly dependant on aerobic metabolism and therefore very sensitive to hypoxia.
• Irreversible neuronal damage occurs after a few minutes.

Question 5

Critical ischaemia

Answer 5

When the neurone receives 30% of normal O2 supply

Question 6

Macroscopic features of CVA

Answer 6

• Soften, loss of definition, pale or haemorrhagic
• Shrunken, yellow, cystic

Question 7

Microscopic features of CVA

Answer 7

• Neuronal necrosis, pallor of myelin, oedema, haemorrhage
• Macrophages, gliosis but no fibrosis, cystic change instead of scarring
• Haemosiderin

Question 8

Clinical presentation of CVA

Answer 8

• Pain
• Decrease or loss of consciousness
• Symptoms and signs are variable and depend on site of damage and function of that area

Question 9

Symptoms and signs of CVA

Answer 9

• Depends on region involved
• Sensory
• Motor
• Speech
• Visual
• Memory
• Tremor

Question 10

What causes patient to die from CVA

Answer 10

• Critical areas are affected (brain stem)
• The damage is too massive
• Increased intracranial pressure can cause coning, (trying to squeeze the brain out of the skull through the foramen magnum)

Question 11

Treatment of CVA

Answer 11

• Thrombolysis
• Clipping of an aneurysm
• Evacuation of blood clot
• Aspirin

Question 12

Prevention of CVA

Answer 12

• Prevention of risk factors
• Stent, bypass
• Aneurysm repair
• Anti-platelet agents

Question 13

Types of stroke

Answer 13

• Ischemic stroke (caused by a clot blocking a blood vessel)
• Hemorrhagic stroke (caused by bleeding within the brain)