Stroke

Question 1

what is stroke

Answer 1

acute focal neurological deficit resulting from cerebrovascular disease and lasting more than 24hrs or causing earlier death

Question 2

what are the 2 types of stroke

Answer 2

infarction of tissue, haemorrhage into the brain tissue

Question 3

what is a transient ischaemia attack (TIA)

Answer 3

rapid loss of function but rapid recovery

Question 4

what is the acronym to spot a stroke

Answer 4

FAST

Question 5

what does FAST stand for

Answer 5

facial drooping, arm weakness, speech difficulty

Question 6

why do TIAs occur

Answer 6

due to platelet emboli from vessels in neck blocking the blood flow to tissue causing ischaemia, these are then rapidly removed

Question 7

what risk comes with having a TIA

Answer 7

greater risk of proper stroke

Question 8

what are the main risks for stroke

Answer 8

hypertension, smoking, alcohol, ischaemic heart disease, atrial fibrillation, diabetes mellitus

Question 9

what are the common causes of stroke

Answer 9

ischaemic stroke, intracranial bleed, embolic stroke, atheroma of cerebral vessels

Question 10

what causes an intracranial bleed

Answer 10

aneurysm rupture

Question 11

how do you prevent a stroke

Answer 11

reduce risk factors, antiplatelets, anticoagulants, carotid endarterectomy (removal of carotid artery/removal of plaque), preventative neurosurgery

Question 12

what antiplatelets are used for stroke

Answer 12

aspirin, clopidogrel, dipyridamole

Question 13

what anticoagulants are used for stroke

Answer 13

warfarin and apixaban

Question 14

when deciding if a stroke is occurring, what do you need to differentiate between?

Answer 14

infarct, bleed and subarachnoid haemorrhage

Question 15

what investigations are used for stroke

Answer 15

CT scan, MRI scan (sometimes), digital subtraction angiography
assessing risk factors

Question 16

how do you assess risk factors for stroke

Answer 16

carotid ultrasound, cardiac ultrasound, ECG, blood pressure, diabetes screen, thrombophilia screen

Question 17

what is the effect of stroke on the brain

Answer 17

loss of functional brain tissue
gradual or rapid loss of function
inflammation in tissue surrounding infarct/bleed

Question 18

what are the complications of stroke

Answer 18

motor function loss, sensory loss and cognitive impairment

Question 19

what does the cognitive impairment aspect of stroke affect

Answer 19

appreciation, processing of information, memory, emotions, speech and language

Question 20

what is the acute phase of managing stroke aiming for

Answer 20

limiting damage to penumbra and reducing future risk

Question 21

what is the chronic phase of managing stroke aiming for

Answer 21

rehabilitation and reducing future risk

Question 22

how do you limit damage to the penumbra

Answer 22

calcium channel blockers (nimodipine)
improve blood flow/oxygenation
normoglycaemia
remove haematoma

Question 23

why is brain glucose level important

Answer 23

as the brain is dependent on glucose for energy so it is not available there will be more damage

Question 24

what drugs are used to prevent future risk of of stroke

Answer 24

aspirin 300mg daily
anticoagulation if indicated

Question 25

what is included in chronic phase treatment for stroke

Answer 25

immobility support, speech and language therapy, occupational therapy

Question 26

what are the dental aspects of stroke

Answer 26

impaired mobility
communication difficulties
risk of cardiac emergencies
loss of protective reflexes
loss of sensory information
stroke pain