Ischemic stroke

Question 1

Stroke

Define:

Answer 1

• abrupt onset of focal neurologic deficit lasting ≥24 hours due to lack of blood flow to the brain*
• resulting from vascular origins*

Question 2

Stroke

Name 3 types:

Answer 2

Ischaemic (80%)

Haemorrhagic

Venous stroke: -mostly thrombosis of sinuses, veins

• no typical imaging appearance
• typically in women, late pregnancy, post-mortem, pregnancy complications)

Question 3

Stroke

risk factors:

Answer 3

• advanced age, male, family history
• modifiable: hypertension, hyperlipidaemia, diabetes, physical inactivity, tobacco use, atrial fibrillation, other cardiac diseases

Question 4

STROKE

FAST signs:

Answer 4

*FAST signs:*

Face uneven,

Arm hanging down on one side,

Speech slurred,

Time (act fast!)

Question 5

Ischemic Stroke

Define :

Answer 5

Ischemic strokes occur when blood supply is cut off to part of the brain.

• This type of stroke a_ccounts for the majority of all strokes._*
• The blocked blood flow in an ischemic stroke may be caused by a blood clot or by atherosclerosis, a disease which causes narrowing of the arteries over time.*

Question 6

Ischaemic Stroke

Pathophysiology:

Answer 6

• - embolus* – most commonly of cardiac origin (endocarditis, valve problems, myxoma)
• thrombosis – most commonly atherosclerosis; others: coagulopathies, polycythemia
• arteriosclerosis (hyalinosis of small arteries) -> lacunar stroke (<1 cm)
• systemic hypoperfusion – cardiac failure, systemic hypotension(blood loss, hypovolemia)

Question 7

Ischaemic Stroke

Other Causes (Etiology):

Answer 7

other causes:

artery dissection (can lead to embolus or narrowing of vessels), patent foramen ovale

Question 8

ischaemic stroke

Diagnosis: Best test

Answer 8

MRI is the best for diagnosing ischaemic stroke

Question 9

ischaemic stroke

Risk factors

Answer 9

Risk factor

• atherosclerosis, smoking & drinking, hypertension, DM, rheumatic disease, age…

Question 10

Ischemic Stroke

Treatment

Answer 10

• thrombolysis – recombinant tPA (Alteplase) – only used within first 4.5 hrs
• thrombectomy – must be performed within first 6 hours
• anti-thrombotics – aspirin, warfarin, heparin
• anti-coagulants – dabigatran, rivaroxaban

Question 11

• Alteplase (t-PA)*
• Define:*

Answer 11

Alteplase (t-PA)

is a thrombolytic medication, used to treat acute ischemic stroke, acute ST-elevation myocardial infarction (a type of heart attack), pulmonary embolism associated with low blood pressure, and blocked central venous catheter.

It is given by injection into a vein or artery.