Neurology - Stroke

Question 1

What is a stroke defined as

Answer 1

acute focal neurological deficit resulting form cerebrovascular disease and lasting more than 24h or causing earlier death

Question 2

What is a store

Answer 2

it is the death of brain tissue from hypoxia due to no local cerebral blood flow

Question 3

What can result in no local cerebral blood flow

Answer 3

infarction of tissue

hemorrhage into the brain tissue

Question 4

What is it called if there is temporary ischemia

Answer 4

transient ischemic attack

Question 5

What are the 4 big symptoms

Answer 5

facial drooping
arm weakness
speech difficulty
time

Question 6

What is a transient ischemic attack

Answer 6

localized loss of brain function due to an ischemic event not a hemorrhage

full recovery within 24 hours but most recover in 30 minutes

results in higher risk of proper stroke

Question 7

What are risk factors for stroke

Answer 7

HYPERTENSION
SMOKING
alcohol
ISCHAEMIC HEART DISEASE
atrial fibrillation
diabetes mellitus

Question 8

How is hypertension such a big risk?

Answer 8

if the diastolic is >110mg then there is a 15x risk compared to diastolic <80mmHg
even borderline hypertension has a risk

Question 9

What are the different types of stroke

Answer 9

ischemic stroke
intracranial bleed
embolic stroke

Question 10

What causes an inter cranial bleed usually

Answer 10

aneurysm rupture

Question 11

What can cause an embolic stroke

Answer 11

embolism coming from left side of the heart

atheroma of cerebral vessels

Question 12

What can cause embolism from the LHS of the heart

Answer 12

atrial fibrillation
heart valve disease
recent MI

Question 13

What can cause an atheroma of a cerebral vessels

Answer 13

carotid bifurcation
internal carotid artery
vertebral artery

Question 14

What are less common causes of stroke

Answer 14

venous thrombosis
borderline infarction
vasculitis

Question 15

What can cause venous thrombosis

Answer 15

oral contraceptive use
polycythemia
thrombophillia

Question 16

How do we prevent stroke

Answer 16

reduce risk factors
anti platelet action
anticoagulants
carotid endarterectomy 
preventative neurosurgery

Question 17

What risk factors can we reduce

Answer 17

smoking
diabetes
control hypertension

Question 18

How is anti platelet action used for stroke prevention

Answer 18

used for secondary prevention only
aspirin
dipyridamole
clopidogrel

Question 19

Why are anticoagulants used for prevention

Answer 19

embolic risk - usually those with AF, LV thrombus

Question 20

What are the common anticoagulants usually given for prevention

Answer 20

warfarin, apixaban

Question 21

What are the preventative neurosurgery

Answer 21

aneurysm clips

AV malformation correction

Question 22

What do we need to figure out in investigation of stroke

Answer 22

need to differentiate cause - is it infarct, bleed or subarachnoid hemorrhage

Question 23

What is used for investigation of stroke

Answer 23

CT scan
MRI
DSA

assess risk factors

Question 24

What are advantages and disadvantages of CT scan

Answer 24

rapid, easy access

poor for ischemic stroke

Question 25

What are advantages and disadvantages of MRI scan

Answer 25

difficult to obtain quickly better at visualizing early changes of damage MRA is the best investigation for visualizing the brain circulation

Question 26

What is DSA used

Answer 26

if MRA not available

Question 27

How do we assess risk factors in investigations

Answer 27

``` carotid ultrasound cardiac ultrasound (LV thrombus) ECG (arythmias) blood pressure diabetes screen thrombophilia screen (young px) ```

Question 28

What is the effect of a stroke

Answer 28

loss of functional brain tissue gradual or rapid loss of function inflammation in tissues around the infart/bleed

Question 29

Why i sheer loss of functional brain tissue

Answer 29

due to immediate nerve cell death | nerve cell ischemia in penumbra around infarction will result in death if not protected

Question 30

What are complications of stroke

Answer 30

``` motor function loss dysphonia swallowing sensory loss cognitive impairment ```

Question 31

How does motor function loss present

Answer 31

can be cranial nerve or somatic (opposite side!) | autonomic is effected in brain stem lesions

Question 32

What are complications of the loss of swallowing in complications

Answer 32

aspiration of food and saliva | pneumonia and death

Question 33

How may sensory loss present

Answer 33

cranial nerve or somatic may be effected (opposite side) | body perception may be different - neglect or phantom limbs

Question 34

How will the cognitive impairment present

Answer 34

appreciation - special sensation processing memory impairment emotional lability and depression

Question 35

How does the processing present

Answer 35

understanding of information | speech and language - dysphasia, dyslexia, dysgraphia, dyscalculia

Question 36

What is the management of stroke in the acute phase

Answer 36

limit damage | reduce future risk

Question 37

What is the management of stroke in the chronic phase

Answer 37

rehabilitation | reduce future risk

Question 38

How do we limit damage in acute phase treatment

Answer 38

penumbra region 0 survivable ischaemia improve blood flow/oxygenation normoglycemia

Question 39

How do we try to save the penumbra region in acute phase treatment

Answer 39

using calcium channel blockers (nimodipine)

Question 40

How do we improve blood flow/oxygenation

Answer 40

thrombolysis possible within 3 hours (alteplase) | maintain perfusion pressure to brain tissue

Question 41

When can we remove the hematoma

Answer 41

in sub arachnoid hemorrhage only

Question 42

How do we prevent future risk

Answer 42

aspirin 300mg daily | anticoagulation if indicated (delay 2 weeksO

Question 43

When are anticoagulants indicated

Answer 43

atrial fibrillation | LV thrombus

Question 44

What is chronic phase treatment

Answer 44

nursing and rehabilitation - immobility support, speech and language therapy, occupational therapy

Question 45

How do we give immobility support

Answer 45

prevention of bed sores | physiotherapy to prevent contractures

Question 46

Why do we give speech and language therapy

Answer 46

communications | swallowing and eating

Question 47

What are dental aspects of stroke

Answer 47

``` impaired mobility and dexterity communication difficulties risk of cardiac emergency loss of protective reflexes loss of sensory information stroke pain ```

Question 48

What is the relevance of sensory information

Answer 48

difficulty in adaption to new oral environment

Question 49

What is the risk fo cardiac emergencies

Answer 49

MI, further stroke