D: Vascular 4 Stroke/TIA/Cerebrovascular - Week 8

Question 1

Define stroke

Answer 1

sudden, focal interruption of cerebral blood flow that causes neurologic deficit

Question 2

What percentage of strokes are ischaemic? And what do these types of strokes typically result from?

Answer 2

80%. Typically result from thrombosis or embolus

Question 3

What percentage of strokes are haemorrhagic? What do these types of strokes result from?

Answer 3

20%. Resulting from vascular rupture (e.g. subarachnoid or intra-cerebral haem)

Question 4

What proportion of stroke/CVA patients recover, die, or have a residual handicap?

Answer 4

1/3rd for each

Question 5

Define Transient Ischaemic Attack (TIA)

Answer 5

stroke symptoms typically lasting less than 1 hour (must be less than 24 hours) and often leaves no or minimal damage

Question 6

List 8 symptoms of stroke. Do they occur suddenly?

Answer 6

Numbness
Parasthesia (tingling)
Weakness
Contralateral limb/face paralysis
Aphasia (speech problems)
Confusion
Visual disturbances (one or both eyes) incl dizzy
Headache

Yeah, they do

Question 7

What symptoms does an anterior circulation stroke typically produce?

Answer 7

unilateral symptoms

Question 8

What symptoms does a posterior circulation stroke typically produce?

Answer 8

unilateral or bilateral deficits (and more likely to affect consciousness, compared to anterior)

Question 9

What 3 features of a stroke are the resultant visual signs and symptoms dependent on?

Answer 9

Location/blood vessels affected
Type of stroke
Effect on cranial nerves

Question 10

List 8 predisposing risk factors for stroke

Answer 10

Age
Atherosclerosis
Uncontrolled hypertension
Diabetes
Smoking
High HDL/LDL levels
Sedentary life style
Blood viscosity disorders

(also note: migraine and carotid artery stenosis)

Question 11

What percentage of stroke patients are over 50 years old?

Answer 11

92%

Question 12

What percentage of strokes are caused by internal carotid artery occlusion?

Answer 12

20%

Question 13

What 4 prodromes may often occur preceding a stroke caused by internal carotid artery occlusion?

Answer 13

TIA
Amaurosis (partial/total blindness)
Speech
Tingling/sensations

Question 14

What percentage of patients with internal carotid artery are asymptomatic at autopsy?

Answer 14

6.5%

Question 15

What types of temporary neurological dysfunctions can occur with TIAs?

Answer 15

somatosensory
motor
vision (amaurosis fugax = painless temporary loss of vision in one or both eyes)

Question 16

What 3 things are TIAs characterised by?

Answer 16

Abrupt onset
Short duration (generally 1-2 mins, 5 mins common, but up to 24 hours)
Complete recovery (with no residual deficit, generally)

Question 17

How does TIA influence the risk of stroke? How long does this apply?

Answer 17

Significantly increases it. In fact, major stroke events commonly occur within the first week after the first TIA.

Risk increases for the next 2 years

Question 18

Define carotid stenosis

Answer 18

Narrowing of the blood vessels in the neck that carry blood from the heart to the brain. Can lead to a TIA.

Question 19

In TIA, in which eye would you expect to experience loss of vision?

Answer 19

Ipsilateral to the existing carotid stenosis

Question 20

In TIA, on what side of your body would you expect motor/sensory defects?

Answer 20

The contralateral side to the existing carotid stenosis

Question 21

What should you ask in history for a patient suspected of having TIAs?

Answer 21

“Do you ever have visual blackouts lasting for a few minutes”

Question 22

What should you ask in history for a patient suspected of having vertebro-basilar TIA?

Answer 22

“Any falls or extreme faints?”

Question 23

List 5 unilateral signs suggestive of carotid insufficiency

Answer 23

Venous stasis retinopathy (VSR)
Ocular ischaemic syndrome
Unilateral pain
Cataract - asymmetric
Dilated conjunctival/scleral vessels

Question 24

List 3 atherosclerotic signs suggestive of carotid insufficiency

Answer 24

BRAO (old or recent)
Hollenhost plaque (cholesterol)
Fisher plug (fibrin)

Question 25

What is Carotid Artery Auscultation?

Answer 25

It’s where you listen at the neck with a stethoscope at the carotid artery to hear the sound it makes

Question 26

What does carotid artery auscultation test for?

Answer 26

narrowing at CC/ICA bifurcation

(ICA = internal carotid artery. CC = common carotid)

Question 27

During carotid artery auscultation: What is a normal sound?

Answer 27

Heart sound (lub-dub)

Question 28

During carotid artery auscultation: What is an abnormal sound? What does this sound indicate?

Answer 28

BRUIT: is a blowing/whooshing sound that indicates significant narrowing of the vessel lumen

Question 29

What does it mean when you hear a louder BRUIT below the CC/ICA bifurcation during carotid artery auscultation?

Answer 29

Suggests a heart anomaly

Question 30

What if you hear no sound during carotid artery auscultation? (2)

Answer 30

Either:
Not correctly positioned on artery (not on artery at all)
Artery completely blocked

Question 31

What does a carotid ultrasound indicate when testing a patient for carotid insufficiency?

Answer 31

indicates degree of stenosis

Question 32

What does ophthalmodymanometry measure?

Answer 32

ophthalmic artery pressure

Question 33

What is a positive result in Ophthalmodymanometry?

Answer 33

20% difference between eyes

Question 34

What 2 treatment options are there for carotid insufficiency?

Answer 34

Anticoagulant therapy (e.g. aspirin)
Surgery - carotid endarterectomy

Question 35

Name 1 benefit and 1 downside of carotid endarterectomy

Answer 35

Advantage: reduces risk of stroke
Disadvantage: but there is a risk of inducing a stroke during the actual operation

Question 36

For what type of patient demographic is carotid endarterectomy mainly indicated for?

Answer 36

younger patients in good health