STROKE

Question 1

What are the diff strokes?

Answer 1

• ischaemic
• thrombotic
• embolic

Question 2

What is stroke?

Answer 2

cerebrovascular event caused by disruption of blood supply to the brain, characterised by rapidly developing neurological signs, lasting for more than 24 hours (or leading to death)

Question 3

Ischameic stroke?

Answer 3

(most common type of stroke-85%)
Occlusion of blood vessel
Can be caused by the formation of a thrombus or an embolus

Question 4

What are thrombotic stroke

Answer 4

Blood clot forming in blood vessel that supplies the brain with blood
Thrombus can occur due to: atherosclerotic plaque rupture or narrowing of arteries (stenosis

Question 5

what is embolic stroke

Answer 5

Blood clot that has formed elsewhere in the body
Cardiac e.g. atrial fibrillation

Question 6

What are the sign of stroke

Answer 6

If there’s no blood flow, no oxygen delivery to tissues & clearance of a waste products such as carbon dioxide–> cells become injured–> eventually leads to cell death & necrosis

Question 6

What is haemorrhage

Answer 6

Intracerebral: bleeding in the brain
Subarachnoid: Bleeding between the brain and the arachnoid mater
Haemorrhages occur when there is a break in a blood vessel
This can occur due to hypertension
However, other causes such as vascular malformations e.g. abnormal connection between the artery & the vein–> the connections are very fragile & are prone to breaking, & causing bleeds

Question 7

What are the risk factors of ischarmic stroke

Answer 7

-Older age
-Atrial fibrillation
-Hypertension (damage to vessel wall)
-Hyperlipidaemia (forms atherosclerosis plaque)
-Diabetes (high blood sugar is directly toxic to vessel wall)
-Obesity (linked to high cholesterol)
-Smoking (directly toxic to vessel wall)
-Alcohol (directly toxic to vessel wall)

Question 8

What do anterior cerebral arteries do?

Answer 8

supplies front/inside of the brain i.e. frontal region, parietal portion of the brain & hippocampus

Question 9

What is haemorrhagic stroke risk factors

Answer 9

• Age 45-70
  -Cerebral aneurysm
  -Family history
  -Hypertension
  -Smoking
  -Alcohol excess/illicit drug use
  -Antiplatelet/anticoagulation (increase risk of bleeding)

Question 10

What do middle cerebral arteries do

Answer 10

supplies front/outside of the brain i.e. temporal region

Question 11

What do posterior cerebral arteries do

Answer 11

supplies back of the brain i.e. occipital lobe

Question 12

What is anterior circulation stroke

Answer 12

-Middle &/or anterior cerebral arteries
-If damage to the right side of the brain, clinical features on the left side of the body EXCEPT for the face; facial symptoms will be on the same side as the damaged part of the brain (vice versa)

Question 13

What are the signs and symptoms

Answer 13

One sided weakness
Loss of sensation
Speech disturbance (if dominant)
Problems with eye movements

Question 14

What are the posterior circulation stroke signs nd symptoms

Answer 14

brain stem:
- complex ; facial weakness, eye movement signs, vertigo
cerebellum:
-Ataxia: describes poor muscle control, group of disorders that affect co-ordination, balance & speech
Nystagmus: rhythmical, repetitive & involuntary movement of the eyes

Question 15

What are the S&S of subarachnoid haemorrhage

Answer 15

‘Thunderclap headache’- severe & sudden onset
Signs of ‘meningism’: stiff neck, photophobia, nausea & vomiting

Question 16

What are the S&S of TIA

Answer 16

Stroke-like symptoms resolve within 24 hours
At higher risk of developing subsequent stroke- greatest risk within 30 days
Important to treat risk factors

Question 17

What are the investigations?

Answer 17

• CT (first line) scan of head to distinguish between haemorhagic and ischameic
• blood tests; clotting, cholesterol,glucose,haemoglobin, infection markers
• further imaging ; MRI head, carotid doppler within 24 hrs
• cardiac; ECG, 24hr tape, echocardiogram

Question 18

What are ways to manage ischaemic stroke

Answer 18

-CT scan shows no blood
-Break the clot using a thrombolysis
-Medication: alteplase
-Needs to be done within 4.5 hours of onset (thrombolysis window)
-Contraindications: bleeding, recent neurosurgery
-If not appropriate from thrombolysis–> 300mg aspirin for 2 weeks, followed by clopidogrel

-Thrombectomy:
Removing the clot under radiological imaging
Specific criteria & location specific

Question 19

What are ways of management of haemorrhagic stroke

Answer 19

-CT shows a bleed
-Depends on extent of bleeding
-Ensure any precipitants of bleeding are stopped (e.g. blood thinners)
-Good blood pressure control
-Neurosurgery

Question 20

What are non-pharmacological ways of management

Answer 20

• admission to a specialist stroke unit
• early rehabilitation
• goal driven care pathway
• swallow assessment

Question 21

What are the secondary preventions?

Answer 21

• anti platelet therapy (prevent further ischameia)
• anticoagulation (atrial fibrillation)
• control BP (hypertensive)
• optimise blood sugar control(diabetes)
• lifestyle advice
  start statis (high cholesterol)
• smoking cessation (smoker)
• excersice/weight loss (obese)
• reduce alcohol

Question 22

what are the impacts of stroke?

Answer 22

Physical disability
Cognitive impairment
Unemployment
Financial problems
Depression
Loss of independence
Loss of self esteem
1/3 require nursing home care