Stroke

Question 1

Define a stroke ?

Answer 1

Interruption of blood supply to area of the brain, causing motor, sensory or behavioural signs. More common in women and Africans

Question 2

What are the risk factors for stroke ?

Answer 2

age, hypertension, smoker, alcohol, overweight, HD, HC, diabetes, family history

Question 3

What are risk factors for stroke in CYP ?

Answer 3

Sickle cell disease, cardiac disease, CHD, cardiac surgery, arteriopathy, infection(varicella zoster, upper respiratory tract, multiple infections), thrombophilia, more common in males.

Question 4

What are the different types of stroke ?

Answer 4

Ischemic - blockage in cerebral artery (most likely carotid or vertebral) stopping blood to an area of the brain.
Haemorrhagic - cerebral artery ruptures, resulting in free blood in the brain.

Question 5

What is the pathophysiology of an ischaemic stroke ?

Question 6

What is the difference between TIA and stroke ?

Answer 6

TIA - transient ischaemic attack
Both sudden but TIA symptoms resolves because the clot breaks up and moves on, usually resolves within 24 hours.

Question 7

What are the risk of a stroke following a TIA ?

Answer 7

2 or more TIA in 7 days - high
AF - high
Severe hypertension - high
high = 8.2% risk on day 2

Question 8

Name some types of brain bleeds

Answer 8

Subdural hematoma, subarachnoid haemorrhage

Question 9

What are symptoms of a stroke ?

Answer 9

Unilateral - one side
Contralateral - opposite side to the damaged area of the brain.
one sided weakness - face, arm, leg
Speech difficulty
visual disturbance - blurred, double, hemianopia
dizziness, loss of coordination, unsteady walk, loss of sensation
Nausea, vomiting, fever.

Question 10

What are the differences between dysarthria and dysphasia ?

Answer 10

Dysarthria - difficulty articulating words, function of tongue and face muscles, slurring or stuttering
Dysphasia - difficulty with language, receptive (don’t understand what they hear), expressive (word finding delay), if severe its like waking up in a foreign country where no one speaks your language.

Question 11

How are different areas of the brain affected ?

Answer 11

Parietal lobe - perception, making sense of the world, spelling, arithmetic.
Occipital lobe - vision
Cerebellum - balance, coordination, posture
Brain stem - sleep, pain, basic body functions, sexual and fighting behaviour
Temporal lobe - memory, understanding, language
Frontal lobe - thinking, planning, emotions, problem solving.

Question 12

Describe the 3 areas of the brain stem

Answer 12

Mid brain - control eye movement, auditory and visual processing, regulates dopamine production (sleep, alertness)
Pons - respiration, swallowing, bladder control, hearing equilibrium
Medulla oblongata - autonomic control of cardiac function, sneezing, coughing, vomiting.

Question 13

How to diagnose a stroke ?

Answer 13

Look for stroke mimics, if no other obvious cause then stroke is diagnosed. Head CT will determine if due to bleed or ischaemia. Wont pick up a very recent ischaemic stroke.

Question 14

How do you diagnose a stroke in CYP ?

Answer 14

AIS and HS can be non-specific (vomiting and fever)
CT within 1 hour
FAST, GCS, AVPU, stroke scale

Question 15

What are some stroke mimics ?

Answer 15

syncope, seizure, Parkinsons, dementia, migraine

Question 16

What are the treatment options for ischaemic stroke ?

Answer 16

Thrombolysis - within 3/4 hours, not suitable for all patients
Clot retrieval thrombectomy - within 6 hours, up to 24 hours if basilar artery occlusion, only if large artery occlusion.
High dose aspirin if not suitable for lysis or CR
Preventable - Antiplatelets / anticoagulation

Question 17

What are the treatment options for a haemorrhagic stroke ?

Answer 17

Identify and treat reversible causes eg warfarin overdose
Lower BP to systolic <140mmhg.
Rehab, physio etc, avoid high ICP, chest infection, aspiration, DVT, pressure sores.

Question 18

What causes a high risk of compromised swallow ?

Answer 18

Loss of muscle power, loss of muscle coordination, loss of sensation/inattention.
Within 4 hours can they stay alert, breathe without gasping, follow commands, sit upright.

Question 19

What is the penumbra ?

Answer 19

Area around the damage that could recover.

Question 20

How does the brain recover from a stroke ?

Answer 20

Some brain cells may only be temporarily damaged and may resume functioning. Sometimes a region of the brain “takes over” for a damaged region. The brain can relearn what was lost. Full impact on the brain may develop over time.

Question 21

What is neuroplasticity ?

Answer 21

Brains ability to remap - learn new tasks, to retrain neurological function. Find a new route, which is often slower and easily forgotten, especially when tired or unwell.