stroke

Question 1

what is the function of the broca and wernicke area

Answer 1

broca: ability to answer
wernicke: ability to understand

Question 2

what are the causes of stroke (iscaemic and haemorrhagic)

Answer 2

ischaemic
1. thrombolic
- atherosclerotic plaque
- large and small vessel
2. embolic
- carotid plaque
- AF
- atherosclerosis

haemorrhagic
1. ICH
- hypertension
- thrombolytic drug
2. SAH
- aneurysm rupture

Question 3

diagnostic tests for stroke

Answer 3

CT: haemorrhagic
CT angiogram: thrombosis, aneurysm
MRI: ischaemic

others: 2D echo, carotid ultrasound and EEG

Question 4

pathophysiology of ischemic stroke

Answer 4

1. reduction of blood flow in the arteries caused by thrombosis or embolism
2. reduction in O2 and glucose
3. lack of energy causes membrane dysfunction and entry of ions
4. oedema of cells occurs followed by death of cell

Question 5

what is the inclusion and exclusion criteria of tpa

Answer 5

inclusion: above 18, <4.5hr
exclusion: ICH and SAH, active internal bleeding, stroke or HI in past 3 months, fibrinogen <100000, anticoagulant (warfarin) or INR>1.5 PT>15, heparin within 48hr, BSL <2.7 or >22.2

Question 6

clinical features of haemorrhagic stroke

Answer 6

severe headache, vomiting and seizure

Question 7

what are the complications of a major rupture (3)

Answer 7

vasospasm, hydrocephalus, rerupture

Question 8

surgical interventions for haemorrhagic stroke

Answer 8

EVD
coiling and clipping of aneurysm (secondary prevention of re bleeding)

Question 9

BP reading pre and post tpa

Answer 9

pre: <185/110mmHg
post: 180/105mmHg

Question 10

what to do if patient has angioedema post tpa

Answer 10

1. stop tpa and protect airway
2. IV methylprednisolone/diphenhydramine
3. SC epinephrine for severe
4. monitor para
5. BP <18-/105 (IV labetalol or nicardipine if needed)

Question 11

what to do if patient suspected of bleeding post tpa

Answer 11

stop tpa
CT scan immediately
take bloods
give cryoprecipitate 10u
recheck fibrinogen after 1hr (1.5 or more)
give cryo 10u again if needed
CT 6hr later

Question 12

what are the neuro complications of stroke

Answer 12

1. TIA: monitor GCS, activate stroke team, prepare tpa or EVT
2. haemorrhagic transformation: motior GCS, HOB 30 deg, prepare cryo (reversal of tpa)
3. concern for malignant MCA infarct: GCS monitor, osmotic therapy and hyperventilation, decompressive crainectomy
4. seizure: monitor, first aid, antiepileptic, prophylactic antiepileptic

Question 13

how to provide fluid management in stroke

Answer 13

isotonic solution
- avoid hypotonic and dextrose
monitor IO
commence feeding (oral or NGT) if permissble

Question 14

what does fever post stroke cause

Answer 14

1. change in BBB
2. cellular acidosis
3. increase in volume of infarcted tissue
4. increased cerebral metabolic demand

Question 15

signs and symptoms of increased ICP (6)

Answer 15

headache
nausea and vomiting
dilated pupil
papilloedema
alteration in level of consciousness
cushing: bradycardia, altered breathing pattern and widening of pulse pressure

Question 16

medical management of raised ICP

Answer 16

HOB 30 deg
IV mannitol 20%
normal saline 3%

Question 17

signs of over/under drainage (6)

Answer 17

drop in GCS
headache
new weakness in limb
change in pupil size and equality
vision change
papilloedema