Stroke

Question 1

Stroke

What are the main pathological causes of ischaemia stroke?

Answer 1

• atherosclerosis
• arterial disease

Question 2

Stroke

What are the risk factors for ischaemic stroke?

Answer 2

The principal risk factors are those for atherosclerosis: age, smoking, dyslipidaemia, diabetes, obesity, inactivity and genetic/ethnic factors

Question 3

Stroke

What is a TIA?

Answer 3

TIAs cause sudden loss of function, usually lasting for minutes only, with complete recovery and no evidence of infarction on imaging.

*The previous classical definition of a duration of less than 24 hours is no longer used. *

Question 4

Stroke

What is Amaurosis fugax?

Answer 4

a sudden transient loss of vision in one eye

Question 5

Stroke

What arteries perfuse these areas?

Answer 5

Question 6

Stroke

A problem with which part of the circulation might bring about these symptoms?

• Amaurosis fugax
• Aphasia
• Hemiparesis
• Hemisensory loss
• Hemianopic visual loss

Answer 6

Anterior circulation
Carotid system

Question 7

Stroke

A problem with which part of the circulation might bring about these symptoms?

• Diplopia, vertigo, vomiting
• Choking and dysarthria
• Ataxia
• Hemisensory loss
• Hemianopic visual loss
• Bilateral visual loss
• Tetraparesis
• Loss of consciousness (rare)
• Transient global amnesia (possibly)

Answer 7

Posterior circulation
Vertebrobasilar system

Question 8

Stroke

What scoring system can we use to stratify stroke risk after TIA in order to guide management?

How do we interpret the score?

Answer 8

ABCD score

**A score of <4 is associated with a low risk whereas >6 is high-risk for a stroke within 7days of a TIA. **

This scoring system is now no longer used to guide management, but may still inform prognosis

Question 9

Stroke

How should we investigate a TIA?

Answer 9

• Doppler ultrasound of the internal carotid arteries
• cardiac echo
• ECG and 24-hour tape
• MRI brain
• MR or CT angiography

Question 10

Stroke

An acute onset (over minutes) of what kind of symptoms are characteristic defining features of ischaemic stroke?

Answer 10

‘negative’ symptoms indicating focal deficits in brain function
- weakness
- sensory loss
- dysphasia
- visual loss

Question 11

Stroke

Complete middle cerebral artery occlusion results in devastating stroke with what kind of features?

Answer 11

• contralateral hemiplegia and facial weakness
• hemisensory loss and neglect syndromes
• eye deviation towards the affected side
• aphasia
• hemianopia

Question 12

Stroke

A complete occlusion of what artery would cause these symptoms:
- contralateral hemiplegia and facial weakness
- hemisensory loss and neglect syndromes
- eye deviation towards the affected side
- aphasia
- hemianopia

Answer 12

MCA

Question 13

Stroke

What are the typical features of an anterior cerebral artery infarct?

Answer 13

• hemiparesis affecting the leg more than arm
• frontal lobe deficits (apathy or apraxia)

Question 14

Stroke

Infarct of what artery would cause this picture:
* hemiparesis affecting the leg more than arm
* frontal lobe deficits (apathy or apraxia)

Answer 14

ACA

Question 15

Stroke

How might an infarct in the posterior cerebral artery present?

Answer 15

• Homonymous hemianopia results from unilateral lesions
• cortical blindness from bilateral lesions
• neglect syndromes + visual agnosias
• confusion or memory impairment.

Question 16

Stroke

The ____ supplies the thalamus, and posteromedial temporal lobe and infarction of these structures causes ____ or ____.

Answer 16

The PCA supplies the thalamus, and posteromedial temporal lobe and infarction of these structures causes confusion or memory impairment.

Question 17

Stroke

Answer 17

Question 18

Stroke

Answer 18

Question 19

Stroke

Answer 19

Question 20

Stroke

Answer 20

Question 21

Stroke

Answer 21

Question 22

Stroke

Answer 22

Question 23

Stroke

Answer 23

Question 24

Stroke

Answer 24

Question 25

# Stroke How should we investigate a stroke pt?

Answer 25

- CT - cardiac investigations (?AF)

Question 26

# Stroke What does FAST stand for?

Answer 26

F ace – sudden weakness of the face A rm – sudden weakness of one or both arms S peech – difficulty speaking, slurred speech T ime – the sooner treatment can be started, the better.

Question 27

# Stroke Outline stroke management.

Answer 27

Thrombolysis significantly increases the chances of having no or minimal disability after stroke, by reducing infarct size *Earlier treatment within the 4.5-hour time window significantly improves outcome, so every minute counts.*

Question 28

# Stroke * Thrombolysis should commence as soon as possible and up to how long after an acute stroke?

Answer 28

4.5hrs

Question 29

# Stroke Which has a worse mortality rate? ischamic stroke or haemorrhagic stroke?

Answer 29

haemorrhagic

Question 30

# Stroke Risk factors for ischaemic stroke: | 10

Answer 30

* Family history * Smoking * Hypertension * Diabetes * Elderly * Atrial fibrillation * Carotid artery stenosis * Hyperlipidaemia * Sickle cell disease * Hypercoagulopathies

Question 31

# Stroke Risk factors for haemorrhagic stroke: | 9

Answer 31

* Family history * Hypertension * Haemophilia * Elderly * Alcohol abuse * Anticoagulation use * Vascular malformation * Use of illicit sympathomimetic substances * Cerebral amyloid angiopathy

Question 32

# Stroke Risk factors for TIA: | 9

Answer 32

* Family history * Hypertension * Smoking * Atrial fibrillation * Elderly * Valvular disease * Diabetes * Carotid artery stenosis * Alcohol abuse

Question 33

# Stroke What are the first line investigations for ischaemic stroke?

Answer 33

* non-contrast ct head * bloods * ech

Question 34

# Stroke What bloods might be get for ischaemic stroke?

Answer 34

* FBC * U&Es * creatinine * Glucose * Troponin * prothrombin time * INR (if on Warfarin or has known chronic hepatic condition such as cirrhosis)

Question 35

# Stroke What drug is given for ischaemic stroke if pt presents to hospital wihtin 4.5hrs? Why?

Answer 35

alteplase - thrombolysis