Diseases of Human Systems - Neurology: stroke

Question 1

What is a stroke?

Answer 1

An acute neurological deficit that results from cerebrovascular disease

Lasts > 24 hours or causes death

Question 2

List the types of stroke.

Answer 2

Infarction:
narrowing and plaque formation which blocks circulation and cells die from hypoxia (commonest)

Haemorrhage:
creates a pressure effect which blocks blood flow to certain parts of the brain

TIA:
Rapid loss of function from ischaemia and rapid recovery within 24 hours (warning sign for a more serious stroke)

Question 3

How do we identify if a patient is having a stoke?

Answer 3

FAST

Question 4

what are the major risk factors for stroke? (6)

Answer 4

Hypertension
Smoking & alcohol
diabetes
Medications - OCP

Ischaemic heart disease
Afib

Question 5

How can we prevent stroke?

Answer 5

Stop smoking

Control diabetes & HT

Take antiplatelets - aspirin and clopidogrel

Take anticoagulants - warfarin, rivaboxaban, apixaban

Surgery - carotid endarectomy

Question 6

What is a TIA?

Answer 6

Rapid loss of function from ischaemia and rapid recovery within 24 hours (warning sign for a more serious stroke)

• occurs due to platelet emboli within the neck which is rapidly removed by the circulation

Question 7

What commonly causes TIA’S?

Answer 7

Platelet emboli from vessels within the neck block the blood flow to the brain.

Rapidly removed by the circulation before permanent damage occurs

Question 8

What causes ischaemic strokes?

Answer 8

unknown

narrowing of the vessels and plaques forming within the vessels

Question 9

What causes haemorrhage strokes? (3)

Answer 9

bleeds from small aneurysm that fails

Embolism from the left side of the heart i.e. in Afib, heart valve disease

Atheroma of cerebal vessels i.e. ICA or vertebral artery

Question 10

What are complications of stroke?

Answer 10

Motor function loss:
Problems with speech, swallowing and walking

Sensory loss:
Lose sensation to the lower half of the face

Cognitive loss:
Memory impairment
Patient loses ownership of parts of their own body = neglect
Phantom limb

Question 11

How is a stroke managed in the acute stages?

Answer 11

Minimising further damage;

Use Ca channel blockers to manage penumbra

(max 3 hours post ischaemic stroke) Thrombolysis

Remove haematoma that’s causing a haemorrhage stroke

Question 12

How is a stroke managed in the chronic stages?

Answer 12

rehabilitation

Question 13

What are the dental implications of a stroke? (5)

Answer 13

Poor manual dexterity - issues with access to the practice and brushing teeth

Difficulty in communication

Risk of further medical emergencies i.e MI or another stroke

Loss of protective reflexes i.e. aspiration

Damage to the brain alters the patients perception of pain