4: Stroke 2 - the sequel

Question 1

What is a stroke?

Answer 1

Loss of brain function secondary to cardiovascular disease

Question 2

There are a lot of diseases which ___ stroke.

Answer 2

mimic

Question 3

Which neurological symptom is most often mistaken for stroke?

Answer 3

Seizure

Question 4

Which widespread infection affecting the major organs can mimic stroke?

Answer 4

Sepsis

Question 5

What is more common - cerebrovascular disease or coronary artery disease?

Answer 5

Cerebrovascular disease

Question 6

Which score is used to assess the likelihood that a patient has suffered a stroke?

Answer 6

ROSIER Score

Question 7

What are the two general types of stroke?

Answer 7

Haemorrhagic

Infarction

Question 8

What colour is

a) blood
b) infarcted tissue

on CT?

Answer 8

Blood is white, well enhancing

Infarcted tissue is black/grey

Question 9

After which length of time is CT NOT sensitive for blood?

Which scan should you use instead after this period?

Answer 9

1 week

MRI

Question 10

Which area of the brain circulation, when infarcted, carries the worst prognosis in stroke?

Answer 10

Anterior circulation

Question 11

What happens to infarcted brain tissue in the weeks following a stroke?

Answer 11

Scarring

Question 12

Which type of stroke has the best prognosis?

Which brain structures are affected?

Answer 12

Lacunar infarction

Basal ganglia, thalamus, brainstem

Question 13

Which area of brain circulation, when infarcted, lead to cranial nerve palsies and blindness ?

Answer 13

Posterior circulation

Question 14

In most people, which side of the brain is dominant?

Answer 14

Left side (most people are right-handed, remember everything is mirrored)

Question 15

Which side of the brain is responsible for musical ability and ‘artistic awareness’?

Answer 15

Right side

Question 16

Which disease processes are responsible for most ischaemic strokes?

Answer 16

Atherosclerosis > Thrombosis > Embolism

Question 17

Which investigation can be used to view blood vessels for thrombosis?

Answer 17

CT / MR angiogram

Question 18

Atherosclerosis affecting the ___ arteries and ___ vessels is the most common reason for ischaemic stroke.

Answer 18

coronary arteries and small vessels

Question 19

Small vessel disease tends to affect the ___ matter of the brain.

Answer 19

white matter

Question 20

Which arrhythmia commonly causes embolism of thrombi to the brain?

Answer 20

AF

Question 21

Why can MI cause embolism of clots to the brain?

Answer 21

Heart isn’t pumping - stasis - Virchow’s triad

Scar tissue also pings off

Question 22

People with ___ valves are more likely to have embolic events.

Answer 22

prosthetic valves

Question 23

Which congenital heart disease can cause a stroke?

Answer 23

Patent foramen ovale

Clots which would usually cause a PE can cross to the left side of the heart and travel to the brain

Question 24

What is an arterial dissection?

Answer 24

Rip in the tunica intima of an artery, allowing blood to get in

Question 25

What are two ways in which arterial dissection causes ischaemic stroke?

Answer 25

**1. Bulging of blood in wall occludes lumen of vessel** **2. Static blood coagulates and can ping off as thromb**i

Question 26

What are two primary causes of **haemorrhagic stroke**?

Answer 26

**Hypertension** **Amyloid angiopathy**

Question 27

What are some causes of **secondary** haemorrhagic stroke?

Answer 27

Tumour, aneurysm, trauma etc. anything which causes bleeding in the cranial cavity

Question 28

\_\_\_ ___ must be reduced in people with primary haemorrhagic stroke.

Answer 28

Blood pressure

Question 29

Bleeding into the cranial cavity causes an increase in what?

Answer 29

ICP

Question 30

Similarly to MIs, time means ___ brain tissue.

Answer 30

lost

Question 31

What is thrombolysis?

Answer 31

Use of drugs to break up clots

Question 32

What is a **side effect** of **thrombolysis**?

Answer 32

**Increased bleeding risk**

Question 33

The ___ and ___ of thrombolysis must be weighed up before starting it.

Answer 33

benefits and risks because they're at risk of bleeding elsewhere

Question 34

What are risk factors for thrombolysis complications?

Answer 34

Age Time since stroke started Co-morbidities Hx previous stroke, hypertension

Question 35

The longer the delay in starting thrombolysis, the (more/less) beneficial it is.

Answer 35

less beneficial

Question 36

When should thrombolysis ideally be given to a stroke patient?

Answer 36

**Within an hour** of symptoms starting

Question 37

Why is a brain scan performed before thrombolysing a patient?

Answer 37

**To check if it's an ischaemic or haemorrhagic stroke** If it's a **haemorrhagic stroke**, ***thrombolysis isn't appropriate***

Question 38

What is a thrombectomy? Who carries it out?

Answer 38

Insertion of a wire to break up larger clots Interventional radiologists

Question 39

Are thrombectomies currently carried out in Scotland?

Answer 39

**Yes** But only in one centre in Edinburgh

Question 40

What other investigations are carried out for patients with suspected strokes?

Answer 40

BP Blood cholesterol ECG

Question 41

What is the **ABCD** of **stroke prophylaxis**?

Answer 41

**Antithrombotic drugs:** antiplatelets (aspirin) and anticoagulants (warfarin) **Blood pressure:** antihypertensives e.g ACE inhibitors, CCBs **Cholesterol:** statin **Diabetic control** **Don't smoke**

Question 42

Which score is used to measure risk of stroke in AF patients?

Answer 42

CHAD2VASC

Question 43

What operation is performed to open up stenosed carotid arteries?

Answer 43

**Carotid endarterectomy**