7: Stroke

Question 1

What is stroke?

Answer 1

Acute onset of neurological symptoms/signs due to disruption of blood supply (ischaemia)

Question 2

Stroke tends to cause ___ rather than death.

Answer 2

disability

Question 3

The majority of stroke is (haemorrhagic / ischaemic).

Answer 3

ischaemic

Question 4

What is a large risk factor in both haemorrhagic and ischaemic stroke?

Answer 4

Hypertension

Question 5

Why may you develop a haemorrhagic stroke?

Answer 5

Poor blood coagulation due to drugs (e.g warfarin, NOACs, anti-platelets)

Structural abnormalities (e.g aneurysm, AVM)

Inflammation (vasculitis)

Question 6

Name three kinds of ischaemic stroke.

Answer 6

Thrombotic (blockage originates in brain)

Embolic (thrombus travels distally and blocks vessel in brain)

Hypoperfusion (BP < 60mmHg, not enough to perfuse brain adequately)

Question 7

What are some non-modifiable risk factors of stroke?

Answer 7

Age

Family history of stroke

Gender

Race

Previous history of stroke

Question 8

What are some modifiable risk factors for stroke?

Answer 8

Hypertension

Hyperlipidaemia

Smoking

Diabetes

(Also: AF, congestive heart failure, alcohol, obesity, exercise, ?deprivation)

Question 9

An important step in diagnosing stroke is ruling out diseases which __ its symptoms.

Answer 9

mimic

Question 10

What are some common stroke mimics?

Answer 10

Hypoglycaemia

Seizures (e.g epilepsy)

Migraines

Brain tumours

Paralysis

Question 11

What are some important questions to ask about stroke in history?

Answer 11

Time of onset?

Was anyone with you?

Standard Calgary-Cambridge

Question 12

What is the only reliable way of differentiating between ischaemic and haemorrhagic stroke?

Answer 12

Brain imaging

e.g CT, MRI scan

Question 13

The large dark area of brain on Slide 21 is ___.

Answer 13

infarcted tissue.

Question 14

The large white spot on Slide 22 is ___ - a sign of ___ stroke.

Answer 14

blood , haemorrhagic

Question 15

If you find infarcts in more than one artery, the clot has likely come from the __.

Answer 15

heart.

Question 16

If you see infarcts on only one side, the clot has likely come from…

Answer 16

the vessel itself.

Question 17

In older patients, the cause of bleed associated with haemorrhagic stroke is likely…

Answer 17

hypertension.

Question 18

If a young person has a haemorrhagic stroke, you should investigate for underyling…

Answer 18

aneurysm, AVM.

Question 19

What does TIA stand for?

Answer 19

Transient ischaemic attack

Question 20

What is a transient ischaemic attack?

Answer 20

Focal neurological symptoms which resolve themselves within a few minutes –> 24 hrs

Question 21

A TIA (is / isn’t) a medical emergency.

Answer 21

is

Question 22

Around 10% of people who have a TIA then go on to have a disabling ___.

Answer 22

stroke

Question 23

What is thrombolysis?

Answer 23

The process of opening a blocked vessel using drugs / mechanical means

Question 24

Patients who have presented very soon after the stroke has started are treated with ___ drugs.

Answer 24

thrombolytic

Question 25

Which drugs are used to manage stroke?

Answer 25

Anti-platelets (aspirin, clopidogrel)

Statins

Anticoagulations if in AF

Question 26

What surgical treatment for stroke literally involves sucking the thrombus out of the vessel?

Answer 26

Haematoma evacuation

Question 27

Parts of the skull may be temporarily removed following stroke to relieve increased ___ pressure.

Answer 27

intracranial pressure