Introduction to stroke

Question 1

Stroke

Answer 1

Abrupt onset

Fit vascular territories

Negative symptoms

Question 2

ACA infarct

Answer 2

Predominantly the contralateral lower limb

Question 3

Left MCA infacrt

Answer 3

Dysphasia, right sided weakness/ numbness

Question 4

Right MCA infarct

Answer 4

Neglect, left sided weakness/ numbness

Question 5

Brainstem infarct

Answer 5

May involve diplopia, visual field defect, facial weakness, contralateral limb weakness/ numbness, incoordination

Question 6

UMN facial weakness

Answer 6

Upper face spared due to bilateral innervation

Question 7

Bells palsy

Answer 7

Unilateral LMN facial weakness

Question 8

Ischaemic

Answer 8

Clot in heart, thrown up to brain

Clot in caortid bifurcation

Atherosclerosis within the vessel

Question 9

Haemorrhage

Answer 9

Surge in blood pressure

Aneurysm burst

Arteriovenous malformation

Question 10

First test to decide if clot or bleed

Answer 10

CT scan

Question 11

Critical ischaemia

Answer 11

High metabolic demand of brain- no glucose stores

<20ml/100g/min- electrical function stops (neurones still alive)

<10ml/100g/min- neuronal death, irreversible ischaemia

Question 12

MRI

Answer 12

Diffusion weighted sequence

Shows ischaemia in 20 minutes

Question 13

Risk factors for stroke

Answer 13

Smoking

Stress

Obesity

Diabetes

Hypertension

Hyperlipidaemia

Question 14

Tests for aetiology

Answer 14

Standard ECG

Echo

Ultrasound of carotid artery

Question 15

Virchov’s triad

Answer 15

Hypercoagulable state

Vascular wall injury

Circulatory stasis

Question 16

Stroke pathophysiology

Answer 16

Endothelial injury

Accumulation of lipoproteins

Monocyte adhesion to the endothelium

Platelet adhesion

Factor release

Smooth muscle cell proliferaion

Lipid accumuation

Question 17

Classification of stroke

Answer 17

Large artery atherosclerosis

Cardioembolism

Small vessel occlusion

Stroke of other determined aetiology

Stroke of undetermined aetiology