cerebrovascular stroke

Question 1

what is a stroke ?

Answer 1

acute neurological deficit that lasts longer than 24hrs

Question 2

what is a transient ischaemic attack ?

Answer 2

acute neurological deficit that lasts less than 24hrs without tissue infarction or tissue injury

Question 3

what are the two types of strokes ?

Answer 3

haemorrhagic stroke

ischaemic stroke

Question 4

what are ischaemic strokes caused by ?

Answer 4

blockage of small vessels
large vessels
cardio-embolic

Question 5

what are hemorrhagic strokes caused by ?

Answer 5

rupture of a blood vessel

Question 6

what are the two ways in which ischemic strokes can happen ?

Answer 6

embolic stroke

thrombotic stroke

Question 7

what is the penumbra ?

Answer 7

tissue around the infarct core that can remain viable for several hours and still salvageable if reperfused the cerebral blood flow is between 17 to 10ml

Question 8

what is the normal cerebral blood flow ?

Answer 8

50ml per 100g per min

Question 9

what is benign oligemia defined as ?

Answer 9

CBF>17 mL

Question 10

what are the main symptoms of a stroke ?

Answer 10

FAST
Face- is one side of the face affected ?
Arm- if you ask the person to raise both arms is one of them downwards
Speech- does the person have slow or slurred speech
Time to call the ambulance

Question 11

what does the Anterior cerebral artery consist of ?

Answer 11

2 parts A1 and A2:
A1 segment is proximal to the anterior communicating artery
A2 is the segment distal to the anterior communicating artery

Question 12

what are the segments of the Middle cerebral artery ?

Answer 12

M1- horizontal segment
M2- insular segment
M3- opercular branches
M4- distal cortical branches

Question 13

what two arteries join to form the basilar artery ?

Answer 13

the two vertebral arteries

Question 14

where does PICA arise from?

Answer 14

distal vertebral arteries

Question 15

where does the AICA arise from ?

Answer 15

the proximal basilar artery

Question 16

where do the SCA arise from ?

Answer 16

from the distal basilar artery just before the bifurcation of the basilar into the posterior cerebral arteries

Question 17

what are the differential diagnosis of stroke ?

Answer 17

 Seizure
 Systemic infection
 Brain tumor
 Vertigo
 Bell Palsy

Question 18

what would the appropriate lab investigations be ?

Answer 18

lipid profile 
blood glucose 
CBC 
urea and creatinine 
clotting profile

Question 19

what radiological imaging can tell us if the stroke is ischaemic or haemorrhagic?

Answer 19

CT scan

Question 20

what radiological investigation can we perform ?

Answer 20

CT scan
MRI scan
CT Angiogram
MR Angiogram

Question 21

National Institutes of Health Stroke Scale (NIHSS) scale ?

Answer 21

42 point scale and is strongly associated with outcome

Question 22

what is ABCD2 system used for ?

Answer 22

Determine the risk for stroke in the days following TIA

Question 23

what are the criteria for ABCD?

Answer 23

-age >60 years
-BP 140/90
-clinical features of TIA:
speech disturbances without weakness
or unilateral weakness
duration of symptoms >60 minutes
DM in the patients history

Question 24

what are recanalization strategies/ reperfusion methods ?

Answer 24

IV ateplase

Intra-arterial approaches (mechanical thrombectomy)

Question 25

what are the treatment of ischaemic stroke ?

Answer 25

• Supplemental oxygen as required (> 94% SaO2)
• Glycemic control
• Optimal blood pressure control •Prevention of hyperthermia

Question 26

what is the long term management of stroke ?

Answer 26

address modifiable risk factors such as smoking and diet and lifestyle changes
Anti platelet therapy
Statins