Stroke

Question 1

Types of cerebrovascular accidents

Answer 1

Ischaemia/ infarction

Intracranial haemorrhage

Question 2

Risk factors

Answer 2

CVD (angina, MI, PVD)

Previous stroke/ TIA

AF

Carotid artery disease

HTN

Diabetes

Smoking

Vasculitis

Thrombophilia

COCP

Question 3

Scoring tool to recognise stroke

Answer 3

ROSIER

Question 4

Management of stroke <4.5h

Answer 4

Exclude intracranial haemorrgage

Thrombolysis with alteplase

Need monitoring for post thrombolysis complications (haemorrhage)

Question 5

Management of stroke >4.5h <6h

Answer 5

Thrombectomy if acute ischaemic stroke and confirmed occlusion of proximal anterior circulation on CTA or MRA

Question 6

Treatment between 6-24h

Answer 6

Thrombectomy if confirmed occlusion of proximal anterior circulation on CTA/MRA and potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion weighted MRI sequences

Question 7

Secondary prevention

Answer 7

Clopidogrel 75mg OD

Aspirin plus modified-release dipyramidole in people who have had ischaemic stroke only if clopidogrel contraindicated (no more than 2 years)

Atorvastatin 80mg (not immediately)

Carotid endarterectomy or stenting in patients with carotid artery disease

Question 8

Contraindications to thrombolysis

Answer 8

Previous intracranial haemorrhage

Seizure at onset of stroke

Intracranial neoplasm

Suspected SAH

Stroke or traumatic brain injury in preceding 3 months

Lumbar puncture in proceeding 7 days

GI haemorrhage in previous 3 weeks

Active bleeding

Pregnancy

Question 9

Initial management of stroke

Answer 9

Admit to specialist stroke centre

Exclude hypoglycaemia

Immediate CT brain to exclude primary intracerebral haemorrhage

Aspirin 300mg stat (oral or rectal) continued for 2 weeks

Question 10

Total anterior circulation infarcts

Answer 10

Involves middle and anterior cerebral arteries

Uinlateral hemiparesis and/or hemisensory loss of face/arm/leg

Homonymous hemianopia

Higher cognitive dysfunction

Question 11

Partial anterior circulation infarcts

Answer 11

Involves smaller anteries of anterior circulation e.g. upper or lower division of middle cerebral artery

2 of the criteria present

Question 12

Lacunar infarcts

Answer 12

Involves perforating arteries around the internal capsule, thalamus and basal ganglia

Presents with 1 of
- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg, or all 3
- pure sensory stroke
- ataxic hemiparesis

Question 13

Posterior circulation infarcts

Answer 13

Involves verterbobasilar arteries

Presents with 1 of
- cerebellar or brainstem syndromes
- LOC
- isolated homonymous hemianopia