Stroke

Question 1

What is a stroke?

Answer 1

Death of brain tissue due to hypoxia and loss of local cerebral blood flow

• due to infarction of tissue
• or haemorrhage into brain tissue

Question 2

What is a TIA?

Answer 2

Transient ischaemic attack

• rapid loss of function then rapid recover of function
• due to blockage of vessel, often from emboli in neck

(Within 24 hrs, mostly 30 mins)

Question 3

What is the stroke acronym?

Answer 3

F - facial drooping

A - arm weakness

S - speech difficulty

T - time this has occurred

Question 4

What are risk factors for stroke?

Answer 4

Hypertension

Smoking

Alcohol

Ischaemic heart disease

Atrial fibrillation

Diabetes Mellitus

Question 5

What are causes of stroke?

Answer 5

Ischaemic stroke - uncertain

Intercranial bleed due to aneurysm

emboli stroke - from LHS heart due to atrial fibrillation or heart valve disease

Atheroma of cerebral vessels e.g. ICA or carotid bifurcation

Venous thrombi - could be from contraceptive pill

Vasculitis - inflammation of vessel walls

Question 6

How can stroke be prevented?

Answer 6

Reduce risk factors
- smoking
- alcohol
- control diabetes and hypertension

Antiplatelets (secondary only)
- aspirin
- clopidogrel

Anticoagulants
- warfarin
- apixaban

Question 7

How to view stroke?

Pro and con for each?

Answer 7

CT scan
- rapid
- poor for ischaemic stroke

MRI
- slow to get
- good for visualising brain circulation

Question 8

Other investigations for someone suffered from stroke? Why?

Answer 8

Carotid ultrasound - ischaemia of carotid artery

Cardiac ultrasound - see eft ventricular thrombi

ECG - check for arrhythmias

Diabetes screening

Blood pressure testing - hypertension risk

Question 9

What are the effects of a stroke on the patient?

Answer 9

Loss of function of Brain tissue due to immediate nerve cell death

• gradual or rapid loss of function in cranial nerves - opposing side
• issue with speech and swallowing
• sensory loss of other side
• memory impairment

Question 10

What are the treatment phases for stroke?

Answer 10

Acute
- reduce damage e.g. remove hematoma
- reduce further risk

Chronic
- rehabilitation - make most of residual function
- reduce further risk

Question 11

Dental considerations of stroke?

Answer 11

• loss of function to carry out oral hygiene
• know signs of stroke FAST
• communication difficulties - dysarthria or dysphonia
• higher risk of cardiac emergency
• loss of sensory information making it hard to adapt to a new oral environment e.g. dentures