Assessment And Management Of Stroke

Question 1

Define stroke

Answer 1

A clinical syndrome consisting of rapidly developing signs of focal disturbance of cerebral function lasting >24 hours due to something vascular

Question 2

Define TIA

Answer 2

A stroke which lasts <24 hours + no evidence of infarction on brain scan

Question 3

Fixed risk factors of ischaemic strokes

Answer 3

Increasing age
Personal/family history of stroke
Ethnicity (what type)

Question 4

Modifiable risk factors of ischaemic stroke

Answer 4

• smoking
• diabetes
• high cholesterol
• hypertension
• AF
• illicit drug use

Question 5

What is an intracererbral haemorrhage?

Answer 5

Bleeding into the brain parenchyma

Question 6

Causes of intracerebral haemorrhage

Answer 6

• hypertension (most common)
• cerebral amyloid angiopathy
• arteriovenous malformations
• anticoagulants
• bleeding from tumours (secondary)

Question 7

What is the most common cause of intracerebra haemorrhage?
How does this occur?

Answer 7

hypertension
- atherosclerotic damage to small blood vessels
- causes aneurysm
- ruptures deep in the brain (basal ganglia)

Question 8

Clinical classification of strokes

Answer 8

Oxford OCSP
Oxfordshire classification of stroke project

Question 9

What are the OCSP classes of stroke?

Answer 9

• total anterior circulation syndrome
• partial anterior circulation syndrome
• posterior circulation syndrome
• lacunar syndrome

Question 10

Indicators of a poor prognosis of strokes

Answer 10

• impaired consciousness
• dense weakness
• urinary incontience
• poor sitting balance
• gaze preference

Question 11

How is stroke severity classified?

Answer 11

NIHSS
National institute of heath stroke score
0-42

Question 12

Early treatment of stroke

Answer 12

• thrombolysis
• thrombectomy
  WHAT ELSe?

Question 13

What is the stroke pathway?

Question 14

Why are stroke units successful?

Answer 14

• prevention of + early recognition + treatment of complications
• intensive monitoring
• early initiation of secondary prevention
• early specialised recognition
• education + training of staff, patients+ carers
• involvement of carers rehabilitation

Question 15

Common complications of strokes + prevention

Answer 15

• pneumonia: sit up, safe swallow + early identification
• pressure sores: positioning, turning + pressure relief
• dehydration/malnutrition: IV fluids, early dietician involvement
• constipation: hydration, laxatives
• incontience
• depression
• spasticity
• seizures

Question 16

NISS classification

Answer 16

• 0 : no stroke symptoms
• 1-4 : minor stroke
• 5-15 : moderate stroke
• 16-20 : moderate/severe stroke
• > 20 : severe stroke

Question 17

Complications of mechanical thromboecomty

Answer 17

• perforation
• embolisation to new territor
• re-perfusion injury
• puncture site complications