Cerebrovascular incl stroke

Question 1

what congenital heart defect is a risk factor for stroke

Answer 1

patent foramen ovale

Question 2

what is the definition of a stroke

Answer 2

focal/global loss of brain function lasting longer than 24hours

Question 3

what feature distinguishes stroke and TIA

Answer 3

TIA lasts less than 24hr

Question 4

what are the 2 main categories of stroke

Answer 4

infract/ischaemic and haemorrhagic

Question 5

what is the commonest type of stroke? (85%)

Answer 5

infarct

Question 6

what pathological finding is found on histology in strokes indicating acute neuronal injury (non-specific)

Answer 6

red neurons

Question 7

ischaemic strokes are further split into categories based on their cause, name these

Answer 7

cardioembolic
atheroembolic/thrombotic
small vessel disease

Question 8

what type of ischaemic stroke causes a fibrin dependent red thrombus and leukoariaosis

Answer 8

cardioembolic

Question 9

what type of ischaemic stroke cause a platelet dependent white thrombus

Answer 9

atheroembolic

Question 10

what is one of the most common sites of atheroembolic strokes

Answer 10

internal carotid bifurcation

Question 11

arteriosclerosis, microaneurysms, vasculitis and amyloidopathies cause what type of ischaemic stroke

Answer 11

small vessel disease

Question 12

what is the major risk factor for cardioembolic stroke

Answer 12

atrial fibrillation

Question 13

where does the thrombus form in cardioembolic strokes

Answer 13

left ventricle

Question 14

rheumatic heart disease and prosthetic valves are associated with what type of ischaemic stroke

Answer 14

cardioembolic

Question 15

does hypertension cause a primary or secondary haemorrhagic stroke

Answer 15

primary

Question 16

do AV malformations cause a primary or secondary haemorrhagic stroke

Answer 16

secondary

Question 17

do aneurysms cause a primary of secondary haemorrhagic stroke

Answer 17

secondary

Question 18

arteriosclerotic small vessel disease is most associated with which intracranial blood vessel

Answer 18

middle cerebral artery

Question 19

5% of strokes are due to what type of intracranial haemorrhage?

Answer 19

SAH

Question 20

what is the watershed area?

Answer 20

where the territory of 2 arteries meet (less well perfused)

Question 21

what is the main cause of wedge infarcts in the watershed area?

Answer 21

hypovolaemic shock

Question 22

what is the commonest visual field defect cause by a stroke

Answer 22

homonymous hemianopia

Question 23

how would a stroke of the middle cerebral artery present

Answer 23

contralateral face & arm weakness.

dominant side: receptive/expressive dysphagia

Question 24

how would a stroke of the anterior cerebral artery present

Answer 24

contralateral leg weakness + sensory loss

Question 25

how would a vertebrobasilar stroke present

Answer 25

vertigo, ataxia, dysarthria, dysphasia

Question 26

DON'T FORGET TO LOOK UP IMAGES OF SCANS FOR HOW TO IDENTIFY HAEMORRHAGIC AND ISCHAEMIC STROKES!!

Answer 26

DO IT

Question 27

investigations for a ptx presenting with stroke like symptoms

Answer 27

``` CT ECG carotid US FBC CRP BP BG lipids ```

Question 28

if a carotid US is +ve when investigating stroke, what test should you do next?

Answer 28

carotid angiogram

Question 29

what test should you do if you suspect a patent foramen ovale?

Answer 29

bubble echo

Question 30

when investigating stroke, if someone has had symptoms for more than 10 days what imaging modality should you do

Answer 30

MRI not CT

Question 31

would an MCA infarct stroke appear hyper or hypodense

Answer 31

hyperdense

Question 32

anterior circulation syndrome can affect which arteries?

Answer 32

anterior cerebral or middle cerebral arteries (both originate from IC)

Question 33

how is anterior circulation syndrome categorised?

Answer 33

TACS total or PACS partial

Question 34

TACS is 3/3 and PACS is 2/3 of what signs

Answer 34

1. homonymous hemianopia 2. cortical sign e.g. dysphagia, neglect 3. ipsilateral motor loss of two of face/arm/leg (+- sensory)

Question 35

lacunary syndrome is due to small deep infarcts, these often effect what type of blood vessel supplying what region of the brain?

Answer 35

penetrating artery | basal ganglia

Question 36

how does lacunar syndrome present

Answer 36

pure motor deficit to 2 of face/arm/leg OR pure hemisensory

Question 37

an isolated homonymous hemianopia is due to what type of stroke

Answer 37

POCS

Question 38

a bilateral motor/sensory deficit is due to what type of stroke

Answer 38

POCS

Question 39

cortical blindness is due to what type of stroke

Answer 39

POCS

Question 40

what type of stroke is a cerebellar stroke?

Answer 40

POCS

Question 41

locked in syndrome is due to a POCS stroke of what region of the brain

Answer 41

pons

Question 42

management of an ischaemic stroke

Answer 42

thrombolysis if <4.5hours. | if over; antiplatelet aspirin

Question 43

what are the 2 methods of thrombolysis

Answer 43

IV tPA or EVT

Question 44

side effects of thrombolysis

Answer 44

bleeding eg. intracranial, stomach ulcer, veneflon site

Question 45

long term management of an ischaemic stroke

Answer 45

after 2 weeks of aspirin, begin long term clopidogrel

Question 46

what is the method of DVT prevention in stroke

Answer 46

intermittent pneumatic compression

Question 47

for patients with AF, following a stroke, what medication should you switch aspirin to?

Answer 47

edoxaban

Question 48

what drugs are options for HTN Mx post stroke

Answer 48

perindopril indapamide amlodipine

Question 49

management of patent foramen ovale to prevent stroke risk

Answer 49

long term aspirin

Question 50

management of carotid stenosis

Answer 50

carotid endarterectomy

Question 51

what is one of the differentiating factors in the presentation of vascular dementia and alzeihmer's? (excluding history of CVD)

Answer 51

vascular dementia has a more abrupt onset

Question 52

what condition are charcot-bouchard microaneurysms associated with

Answer 52

long standing HTN