Stroke

Question 1

What are the risk factors for strokes?

Answer 1

non modifiable

• > 55 years of age
• males
• family history of stroke in young

modifiable

• HTN
• DM
• atrial fibrillation
• hyperlipidemia
• smoking

Question 2

What are the types of stroke & their causes?

Answer 2

Ischemic

• atherosclerosis
• cardio-embolic -> AF
• athero-embolic -> ICAD, CAS

Hemorrhagic

• intracerebal -> HTN, amyloid, coagulopathy
• subarachnoid -> aneurysms

Venous
- CVST

Question 3

How does a stroke present?

Answer 3

sudden onset of neurological symptoms

• right sided -> APATHY, left hemiparesis, neglect, visual field defects, hemianesthesia
• left sided -> APHASIA, right hemiparesis, visual field defect, hemianesthesia
• posterior -> cranial nerve defects, vertigo, nystagmus, ataxia, crossed findings

Question 4

How are strokes diagnosed?

Answer 4

CT -> best

• fast & detects hemorrhagic strokes
• can miss early ischemic strokes (<6hrs)

MRI

• can detect both types
• time-consuming

Question 5

How is ischemic stroke managed?

Answer 5

if <4.5 hrs
- alteplase

if >4.5hrs or large vessels are occluded
- angiogram & thrombectomy

Question 6

How are hemorrhagic strokes managed?

Answer 6

1- control hypertension -> prevent expansion of hematoma & edema
2- correct coagulopathy incase patient was on anticoagulants -> FFP, cryo, platelets transfusion

Question 7

What is the secondary prevention of ischemic strokes?

Answer 7

• risk factor modification
• in case of atherosclerosis -> anti platelets & high dose statins
• in case of AF -> anticoagulation

Question 8

What is the secondary prevention of hemorrhagic strokes?

Answer 8

• control HTN

Question 9

What is the cause of lacunar infarcts?

Answer 9

lipohyalinosis of penetrating vessels

Question 10

What is the cause of wedge shaped infarcts?

Answer 10

cardiac embolism

Question 11

What are the side effects of alteplase therapy?

Answer 11

hemorrhagic transformation