CLINICAL ASPECTS OF A STROKE

Question 1

what is the 3rd most common cause of death?

Answer 1

stroke

Question 2

what are symptoms of a stroke?

Answer 2

facial weakness
arm weaness
speech problems
dizziness
vertigo
loss of vision
memory loss
etc

Question 3

what is a stroke?

Answer 3

a sudden focal neurological deficit due to a vascular lesion that lasts longer than 24 hours

Question 4

what is a transient ischaemic attack?

Answer 4

a focal deficit lasting from a few seconds to up tp 24 hours due to a temporary blockage of bloodflow to the brain with a complete clinical recovery

Question 5

what types of symptoms would a frontal lobe stroke present with?

Answer 5

speech difficulties
ataxia
hemiparesis or hemiplegia
personality changes
incontinence

Question 6

what symptoms would you expect with a parietal lobe stroke?

Answer 6

aphasia
alexia
hemiagnosia
inferior quadrantanopia
proprioception dysfunction
apraxia
Gerstmann syndrome

Question 7

what is Gerstmann syndrome?

Answer 7

a lesion in the dominant parietal lobe that causes…
ibaility to write spontaneously
inability to distinguish between L and R
finger agnosia (inability to name fingers)
acalculia

Question 8

what symptoms would you expect with a temporal lobe stroke

Answer 8

poor memory
proaopagnosia 
impaired speech
diffuclty with depth perception
emotional or behavioural changes

Question 9

what symptoms would you expect with an occipital lobe stroke?

Answer 9

homonomous hemianopia, central visual deficits, cortical blidness or anton syndrome (not being aware of own blindness)

Question 10

what is a lacunar stroke?

Answer 10

a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked

Question 11

what are the 2 major pathologies of stroke?

Answer 11

ischaemic stroke - blocked artery

haemorrhagic stroke - bursting of a blood vessel

Question 12

whats the main cause of an ischaemic stroke?

Answer 12

atherosclerosis - plaques are very thrombogenic so can occlude a vessel or release emboli

Question 13

what are causes of haemorrhagic strokes?

Answer 13

head injuries, coagulation disorders, hypertension, cerebral aneurysms or cerebral amyloid angiopathy

Question 14

what is cerebral amyloid angiopathy?

Answer 14

proteins called amyloid build up on the walls of the arteries in the brain.

Question 15

what is the ischaemic penumbra?

Answer 15

the hypoperfused tissue around the ischaemic core in which blood flow is too low to maintain electrical activity but is sufficient to preserve ion channels so if it is saved quickly with re-perfusion, function may return

Question 16

what are the symptoms of an anterior carotid artery occlusion?

Answer 16

contralateral hemiplegia
hemisensory distubrance 
homonymous hemianopia
deteroiration in consciousness
gaze palsy, global aphasia

Question 17

what are the 2 mechanisms of cell death in an ischaemic stroke?

Answer 17

Na+ build up - water follows = swelling

Ca2+ build up - creates oxygen free radicals which damage mitochondrial and lysosomal lipid membranes

Question 18

what are the 2 main causes of lacunar infarcts?

Answer 18

lipohyalinosis - build up of hyaline in arterioles wall -> hypertrophy of tunica media -> progressive narrowing of arterioles until blood stops

microatheromatoma - narrowing of blood vessels due to debris accumulation within walls

Question 19

what are stroke risk factors?

Answer 19

>55 years 
biologically male 
black individuals of african descent
migraine headaches with aura
genetics 
haematological disorders e.g. multiple myeloma, SC, plycythemia vera
hypertension
diabetes
heart disease
high cholesterol
smoking
physical inactivity
cocaine abuse

Question 20

what are the signs of lacunar stroke

Answer 20

contralateral , mostly motor or senaory defects
e.g. pure motor stroke = internal capsule lesion
pure sensory stroke = thalamus lesion

Question 21

what are the signs and symptoms of a MCA stroke?

Answer 21

contralateral paresis, sensory deficit, inability to understand and produce speech, hemispatial neglect, homonymous hemianopsia, deviation of eye to damaged side

Question 22

what are signs of PCA stroke?

Answer 22

homonymous hemianopsia
cortical blidness if lesion is bilateral
dilated pupil
imapired memory and altered consciousness (thalamus)
wallenberg syndrome, dizziness, nystagmus, speech and swallowing difficulties, facial sensory loss, horners sign, ataxia, loss of pain/temp/sensation in limbs

Question 23

what would be the signs and symptoms of a basilar/vertebral artery stroke?

Answer 23

dizziness, gait, vision disorder, dysarthria, dysphagia, locked in syndrome

Question 24

what medication can we give to treat an ischaemic stroke?

Answer 24

thrombolytic enzymes e.g. rtPA if caught within 4.5 hours

antiplatelet therapy e.g. aspirin or clopidogrel

Question 25

what do we do for hypertension in ischaemic stroke?

Answer 25

IV labetalol or nicardipine

Question 26

how do we manage cerebral oedema in ischaemic stroke?

Answer 26

antipyretics if high temp
IV insulin
pevention with anticoagulant medication e.g. warfarin and aspirin

Question 27

what is a thrombectomy?

Answer 27

a surgical procedure to remove blood clots from arteries and veins

Question 28

how do we manage haemorrhagic strokes?

Answer 28

lower bp to <160-90
reverse anticoagulation if possible to reduce excessie bleeding
sugrery to repair vessels sometimes

Question 29

what proportion of patients cannot swallow on day 1 after stroke?

Answer 29

45%

Question 30

what are some long term problems of strokes?

Answer 30

mobility problems
bladder and bowel incontinence
cognition difficultes
self care troubles
communciation deficits
pain
up to 50% have depression afterwards

Question 31

what proportion of people are disabled 5 years after a stroke?

Answer 31

36%

Question 32

how many stroke victims die within a month?

Answer 32

19%

Question 33

how many stroke victims die within a year?

Answer 33

31%

Question 34

what is the percentage risk of having another stroke within a year of your first?

Answer 34

15%