Ischaemic Stroke

Question 1

An ischaemic stroke is a focal n_____ deficit lasting __ hours+ with infarction

Answer 1

neurological, 24+ hours

Question 2

What percentage of strokes are ischaemic?

Answer 2

85%

Question 3

What does infarction refer to?

Answer 3

Tissue death due to ischaemia

Question 4

What may disrupt the blood supply to the brain?

Answer 4

A thrombus or embolus
Atherosclerosis
Shock
Vasculitis

Question 5

Stroke symptoms are typically asymmetrical and include…

Answer 5

Limb weakness
Facial weakness
Dysphasia (speech disturbance)
Visual field defects
Sensory loss
Ataxia (co-ordination, balance and speech)
Vertigo (sensation that you or everything else is moving/spinning)

Question 6

What are risk factors for strokes?

Answer 6

Previous stroke or TIA
AF
Carotid artery stenosis
Hypertension
Diabetes
Raised cholesterol
Family history
Smoking
Obesity
Vasculitis
Thrombophilia
Combined contraceptive pill
Age
Male
Black African
Migraine headaches with aura
Genetics
Multiple myeloma
Sickle cell disease
Physical inactivity
Cocaine abuse

Question 7

What is a simple way of identifying a stroke in the community?

Answer 7

FAST

Face
Arm
Speech
Time (act fast, call 999)

Question 8

What tool is used to score a stroke based on clinical features and duration?

Answer 8

ROSIER tool (Recognition Of Stroke In the Emergency Room)

Question 9

What is initial management of a patient presenting with a stroke?

Answer 9

Exclude hypoglycaemia
Immediate CT scan to exclude haemorrhage

Aspirin 300mg daily for 2 weeks (once haemorrhage excluded)
Admission to specialist stroke centre

After 2 weeks of aspirin, lifelong clopidogrel (antiplatelet)

Question 10

What drug is considered for ischaemic stroke to aid thrombolysis?

Answer 10

Alteplase

Question 11

How does Alteplase work?

Answer 11

Tissue plasminogen activator to rapidly break down clots

Question 12

True of false: in patients with ischaemic stroke, you want to lower the blood pressure

Answer 12

False
Lowering blood pressure can worsen the ischaemia

Question 13

When is thrombectomy considered in cases of ischaemic stroke?

Answer 13

When there is a blockage of the proximal anterior circulation or proximal posterior circulation.
Carried out alongside IV thrombolysis

Question 14

How is carotid artery stenosis investigated?

Answer 14

Carotid ultrasound or CT or MRI angiogram

Question 15

How is atrial fibrillation investigated in stroke patients?

Answer 15

ECG or ambulatory ECG monitoring

Question 16

How do you manage a patient who’s ischaemic stroke was due to atrial fibrillation?

Answer 16

After finishing 2 weeks of aspirin, give anticoagulants (often DOAC like apixaban)

Question 17

What surgical interventions are available for carotid artery stenosis causing a stroke?

Answer 17

Carotid endarterectomy
Angioplasty and stenting

Question 18

Around what proportion of strokes in the UK are due to narrowing of the carotid arteries?

Answer 18

25%

Question 19

What is secondary prevention for strokes?

Answer 19

Clopidogrel daily (antiplatelet)

Atorvastatin (lower LDL)
Ramipril (Ace-inhibitor for high bp)

Diabetes control
Addressing modifiable risk factors

Question 20

During an ischaemic stroke there is blood vessel obstruction causing hypoperfusion and tissue hypoxia. This lack of oxygen means that less ___ is made due to disturbance in electron transport chain. Therefore, cell cannot function and leads to cell death.

Answer 20

ATP

Question 21

What is a very common type of ischaemic stroke of lenticulostriate arteries?

Answer 21

Lacunar strokes
(supplies deep brain structures: basal ganglia, internal capsule, thalamus, pons)

Question 22

If a patient is on oral anticoagulants, suspect _______ stroke until proven otherwise

Answer 22

haemorrhagic

Question 23

Why should a non-contrast CT head scan be used for a stroke?

Answer 23

Very quick, determines haemorrhagic or ischaemic cause. Using contrast takes longer, more widely available, smaller risk of adverse reactions like allergic reaction.