Stroke

Question 1

What are the 2 different types of Stroke?

Answer 1

1. Ischaemic stroke (87%)
2. Haemorrhagic stroke (13%)

Question 2

How do Ischaemic strokes occur? (2 steps)

Answer 2

1. Blood supply to area of brain tissue reduced
2. Tissue hypoperfusion

Question 3

What are the mechanisms that can cause an Ischaemic Stroke? (4 things)

Answer 3

1. Embolism
2. Thrombosis
3. Systemic hypoperfusion
4. Cerebral venous sinus thrombosis

Question 4

How does an Embolism result in an Ischaemic stroke? (3 steps)

Answer 4

1. Embolus originates somewhere (e.g heart)
2. Causes obstruction to Cerebral vessel
3. Hypoperfusion to part of brain

Question 5

How does Thrombosis result in an Ischaemic stroke?

Answer 5

Blood clots forms WITHIN cerebral vessel

(bc atherosclerotic plaque rupture)

Question 6

How does Systemic Hypoperfusion result in an Ischaemic stroke? (2 points)

Answer 6

1. Blood supply to ENTIRE brain reduced
2. Secondary to systemic hypotension (e.g cardiac arrest)

Question 7

How does Cerebral venous sinus thrombosis result in an Ischaemic stroke? (3 steps)

Answer 7

1. Blood clot forms in veins that drain brain
2. Venous congestion
3. Tissue hypoxia

Question 8

How do Haemorrhagic strokes happen?

Answer 8

Secondary to rupture of a blood vessel in brain

Question 9

What are the 2 subtypes of Haemorrhagic strokes?

Answer 9

1. Intracerebral haemorrhage
2. Subarachnoid haemorrhage

Question 10

What doe Intracerebral haemorrhages involve?

Answer 10

Bleeding WITHIN brain

(secondary to ruptured vessel)

Question 11

What are the 2 subtypes of Intracerebral haemorrhages?

Answer 11

1. Intraparenchymal (within brain tissue)
2. Intraventricular (within ventricles)

Question 12

What do Subarachnoid haemorrhages involve?

Answer 12

Bleeding OUTSIDE brain

Question 13

Where does the bleeding in Subarachnoid haemorrhages happen?

Answer 13

Between Pia mater + Arachnoid mater

Question 14

What does TIA stand for?

Answer 14

Transient Ischaemic Attack

Question 15

What was the original definition of TIAs?

Answer 15

Stroke symptoms that resolve within 24 hours

Question 16

What is the new definition of TIAs?

Answer 16

Transient neurological dysfunction secondary to ischaemia WITHOIT infarction

Question 17

What do TIAs often precede?

Answer 17

Full stroke

Question 18

What do you call it when someone has 2+ TIAs within 1 week?

Answer 18

Crescendo TIA

Question 19

What is the ONSET of Stroke CF?

Answer 19

Sudden

Question 20

Are Stroke CF symmetrical or asymmetrical?

Answer 20

Asymmetrical

Question 21

What are the CF of Stroke? (4 things)

Answer 21

1. Limb weakness
2. Facial weakness
3. Dysphasia (speech disturbance)
4. Visual / sensory loss

Question 22

What are the RF for Stroke? (9 things)

Answer 22

1. CVS disease (e.g angina / MI / PVD)
2. Stroke / TIA Hx
3. AF
4. Carotid artery disease
5. HTN
6. DM
7. Smoking
8. Thrombophilia
9. COCP

Question 23

What are the NICE guidelines MAIN points of Mx of Stroke? (4 things)

Answer 23

1. Admit pt to specialist stroke centre
2. Exclude hypoglycaemia
3. CT brain (immediately to exclude Primary Intracerebral Haemorrhage)
4. Aspirin 300mg stat

Question 24

How long should Stroke pt continue Aspirin for?

Answer 24

2 weeks

Question 25

Once the CT brain has excluded Primary Intracerebral Haemorrhage, what medication can you use?

Answer 25

Altepase (for thrombolysis)

Question 26

What is Alteplase?

Answer 26

Tissue plasminogen activator

Question 27

How does Alteplase work? (2 things)

Answer 27

1. Breaks down clots 2. Reverses stroke effects (if given in time)

Question 28

What is the time window Alteplase must be given within?

Answer 28

4.5 hours

Question 29

What complications should you monitor for after Thrombolysis with Alteplase?

Answer 29

Intracranial / systemic haemorrhage

Question 30

How should you monitor for these Post-thrombolysis complications?

Answer 30

CT brain

Question 31

If CT scan confirms an occlusion, what should be offered?

Answer 31

Thrombectomy (mechanical removal of clot)

Question 32

What is the time window Thrombectomy must be done within?

Answer 32

24 hours since onset of symptoms

Question 33

What are the Mx options for TIA? (3 things)

Answer 33

1. Aspirin 300mg daily 2. Secondary prevention measures for CVS diseases 3. Refer to Stroke specialist within 24 hours

Question 34

What are the Secondary Prevention measures of CVS diseases for TIA / Stroke? (4 things)

Answer 34

1. Clopidogrel 75mg OD 2. Atorvastatin 80mg (but not immediately) 3. Carotid endarterectomy / stenting (in pt w CAD) 4. Treat modifiable RF (e.g HTN / DM)