STROKE

Question 1

What is stroke

Answer 1

Sudden global or focal neurological
deficit resulting from spontaneous hemorrhage or infarction of the
central nervous system, with objective evidence of an infarction or hemorrhage, irrespective of the duration of clinical symptoms

Question 2

……….. or …………….. is required to make the diagnosis and exclude other intracranial lesions that could present similarly

Answer 2

CT or
MRI scan

Question 3

What is TIA

Answer 3

is a transient
episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia.

Question 4

There is no objective evidence of acute infarction in the affected region of brain or retina in TIA . T/F

Answer 4

T

Question 5

Causes of cerebral infarction

Answer 5

Thrombosis
Embolism

Question 5

Important risk factors of stroke in children

Answer 5

sickle cell disease
cyanotic heart disease

Question 6

Risk factors of stroke

Answer 6

hypertension
diabetes
dyslipidemia
atrial fibrillation
smoking

Question 7

Causes of stroke

Answer 7

Cerebral infarction
Intracerebral hemorrhage
Subarachnoid hemorrhage

Question 8

Symptoms of stroke

Answer 8

Weakness of one side of the body including the face
Inability to rise up from a sitting or lying position
Sudden fall/collapse
Loss of speech
Loss of vision
Unconsciousness in some patients
Seizures

Question 9

Severe headache and/or neck pain is seen in ……………..

Answer 9

subarachnoid hemorrhage

Question 10

What is hemianopia

Answer 10

loss of one-half of visual field

Question 10

Neck stiffness is seen in …………..

Answer 10

Subarachnoid hemorrhage

Question 11

Signs of stroke

Answer 11

Paralysis of a limb
Facial paralysis
Initial flaccidity of limbs, but later spasticity and exaggerated reflexes
Hemianopia
Hemi-anaesthesia
Extensor plantar response
Dysarthria/dysphasia
Neck stiffness (in subarachnoid haemorrhage

Question 12

What is Hemi-anaesthesia

Answer 12

loss of sensation of one-half of body

Question 13

Treatment objectives in stroke

Answer 13

To limit the area of brain damage
To protect patients from the dangers of unconsciousness and immobility
To prevent aspiration
To treat the underlying cause if possible
To identify and manage modifiable risk factors
To institute measures to improve functional recovery To support and rehabilitate patients who survive with residual disability
To minimize adverse effects of drug therapy

Question 14

Investigations in stroke

Answer 14

FBC, ESR
Blood glucose
Serum lipid profile
BUE/Cr
Uric acid
ECG
CT scan/MRI of the head
Chest X-ray

Question 14

Non-pharmacological management of stroke

Answer 14

1. Monitoring
2. Establish adequate airway in unconscious patients
3. Swallowing test in an upright position
4. Insert nasogastric tube
   5.Nurse in the lateral position with suctioning where necessary
5. Elevate head of bed
6. Prevent pressure sores by regular turning (every 2 hours) in bed
7. Maintain adequate hydration
8. Keep patient clean and dry by frequent use of bedpan/urine pot, diapers, condom catheter as required. Urethral catheter should be used only if absolutely necessary
9. Start physiotherapy as soon as practicable

Question 15

How often should a stroke patient’s vital signs and neurological signs be monitores

Answer 15

Every 4 hours

Question 16

Volume of water used for the swallow test

Answer 16

10 to 15ml

Question 17

Purpose of nasogastric tube

Answer 17

Feeding and Nutrition

Question 18

Which patients will require a nasogastric tube and why

Answer 18

unconscious patients or those with swallowing difficulties to prevent aspiration

Question 19

At what angle should the stroke patients head be elevated to and why

Answer 19

30 degrees to reduce intracranial pressure

Question 20

Pharmacological treatment of infarctive stroke and TIA

Answer 20

Aspirin
and
Atorvastatin or Rosuvastatin

Question 26

Dose of rosuvastatin increased

Answer 26

Adults
20-40 mg daily
Children
Not recommended

Question 26

Should oral metformin be given in acute stroke

Answer 26

No

Question 26

RBS target in stroke

Answer 26

4 to 10 mmol/l

Question 26

Dose of aspirin

Answer 26

Aspirin, oral,
Adults
300 mg stat.
Then
75 mg daily
Children
> 16 years; same as adult dose
< 16 years; not recommended

Question 26

Dose of atorvastatin

Answer 26

Adults
40-80 mg daily
Children
Not recommended

Question 27

Blood pressure management in stroke

Answer 27

If > 180/110 mmHg aim for gradual reduction
of no more than 20% over 24 hours.

Question 27

Dose of hemorrhagic

Answer 27

Mannitol, IV,
Adults
0.5-1 g/kg 6 hourly (up to 2 g/kg per dose)
Children
1 month-18 years; 0.5-1.5 g/kg
Or 2.5-7.5 ml/kg of 20% solution

Question 27

Should SL nifedipine be used in BP management in stroke patients

Answer 27

No

Question 27

Which fluids should be avoided in stroke

Answer 27

Dextrose 5% or 10% unless patient is hypoglycaemic

Question 27

Which fluids should be used for hydration in stroke

Answer 27

Normal saline
Dextrose saline

Question 28

Therapies to reduce ICP in stroke

Answer 28

Nurse at 30 degrees head up
IV mannitol
Dexamethasone

Question 29

Treatment for aspiration pneumonia in stroke

Answer 29

IV Amoxiclav and IV metronidazole for first 48 hours then review

Question 30

Algorithm for stroke management

Answer 30

History and
examination
Investigations
Hydration
Stress ulcer prophylaxis
Glucose control
Pyrexia
BP management
Treatment of infarcts
Atrial fibrillation
Mobilisation of patients
Aspiration pneumonia
DVT and PE prophylaxis
Seizures
Change in consciousness level
Increased ICP
High cholesterol

Question 31

Factors that can cause change in consciousness level in stroke

Answer 31

cerebral oedema
hypoglycaemia
metabolic
drugs

Question 32

Treatment of infarcts in stroke

Answer 32

aspirin 300 mg stat as soon as infarct identified via (oral/
NG) if no contraindications. Reduce dose to 75 mg daily after 1
week, and consider further anti-platelet medication