Stroke

Question 1

How many neurones die every minute until blood flow is restored in an acute stroke?

Answer 1

1.9 million

Question 2

What is the NIHSS?

Answer 2

The National Institute of Health Stroke Scale

Question 3

What is first line imaging in acute stroke?

Answer 3

CT head non-contrast

Question 4

What hyperacute changes can be visualised on CT head in a stroke?

Answer 4

1. Visualisation of a clot (as early as immediate)

2. Early parenchymal changes (early as 60 minutes post stroke)

Question 5

What imaging allows us to definitively find the causative clot in acute stroke?

Answer 5

CT Angiography

Question 6

What happens between the white and grey matter following an acute stroke?

Answer 6

There is loss of differentiation between the tissues which becomes obvious on CT head

Question 7

When is the cut off for thrombolysis according to the most up to date evidence/guidance?

Answer 7

Thrombolyse within 4.5 hours of stroke onset

Question 8

What are the 2 warning complications of thrombolysis in acute stroke?

Answer 8

1. 6% risk of haemorrhage

2. 7% risk of angioedema

Question 9

What medication do we give to thrombolyse?

Answer 9

Alteplase

Question 10

What is the dose of alteplase?

Answer 10

0.9mg/kg IV infusion within 1 hour

Question 11

What needs to be done before someone receives thrombolysis?

Answer 11

1. Blood tests
2. CT head
3. Specialist review

Question 12

What are the 2 strongest predictors of outcome in an acute stroke?

Answer 12

Age and stroke severity

Question 13

What percentage of acute strokes are ischaemic?

Answer 13

85%

Question 14

What percentage of acute strokes are haemorrhagic?

Answer 14

15%

Question 15

How quickly must a patient recover from a “funny turn” to be classed as a Transient Ischaemic Attack?

Answer 15

Within 24 hours

Question 16

What is a crescendo TIA?

Answer 16

2< episodes of TIA within 1 week -this needs urgent evaluation by a specialist

Question 17

When a TIA is suspected by a GP, where should they refer the patient?

Answer 17

To a specialist TIA clinic to be seen in 24 hours

Question 18

What should a patient with a suspected TIA be prescribed?

Answer 18

Aspirin 300mg

Question 19

What investigations should be carried out in a TIA clinic?

Answer 19

1. Blood glucose
2. ECG
3. Height, weight BMI
4. Bloods: FBC, U&Es, LFT, lipids
5. Carotid artery US doppler

Question 20

What symptoms would you see in a right handed patient with an occlusion in the following artery, and which parts of the brain would it affect; right posterior cerebral artery?

Answer 20

Affects; upper midbrain, occipital cortex, thalamus, medial temporal lobes
Causes; visual field defects, motor or sensory loss

Question 21

What symptoms would you see in a right handed patient with an occlusion in the following artery, and which parts of the brain would it affect; left posterior cerebral artery?

Answer 21

Affects; upper midbrain, occipital cortex, thalamus, medial temporal lobes
Causes; visual field defects, motor or sensory loss

Question 22

What symptoms would you see in a right handed patient with an occlusion in the following artery, and which parts of the brain would it affect; Right middle cerebral artery?

Answer 22

Affects; right left fronto-parietal cortex and subcortical structures
Causes; neglect, left motor and sensory deficits

Question 23

What symptoms would you see in a right handed patient with an occlusion in the following artery, and which parts of the brain would it affect; left middle cerebral artery?

Answer 23

Affects; left fronto-parietal cortex and subcortical structures
Causes; dysphasia, right visual field defect, right motor and sensory deficits

Weakness most likely in the face then the arm then the leg

Question 24

What symptoms would you see in a right handed patient with an occlusion in the following artery, and which parts of the brain would it affect; right anterior cerebral artery?

Answer 24

Affects; right frontal and parasagittal areas

Causes; behavioural changes, weakness (legs>arms)

Question 25

What symptoms would you see in a right handed patient with an occlusion in the following artery, and which parts of the brain would it affect; left anterior cerebral artery?

Answer 25

Affects; left frontal and parasagittal areas

Causes; speech disturbance, behavioural changes, weakness (legs>arms)