stroke

Question 1

who does stroke most likely effect

Answer 1

older people with vascular disease

Question 2

how many people die within the first year of stroke

Answer 2

1/3

Question 3

what is the definition of a stroke

Answer 3

a sudden onset of focal or global neurological symptoms caused by ischemia or hemorrhage and lasts more then 24/hrs

Question 4

what percentage of strokes are ischsemic and haemorrhagic

Answer 4

85% Ischemic
15% Haemorragic

Question 5

what is difference of a stroke vs TIA

Answer 5

symptoms resolve in 24hrs most in 1-60 mins

Question 6

what is main imaging used for stroke

Answer 6

CT scan

Question 7

what are the main causes of ischemic stroke

Answer 7

large atherosclerosis eg the internal carotid
cardioembolic atrial fibrillation
small artery occlusion (lacunar strokes)
rare causes - VST snd arterial dissection

Question 8

what are the main causes of hemorrhagic stroke

Answer 8

primary intercerebral hemorrhage

Question 9

secondary hemorrhage

Answer 9

subarachnoid hemorrhage

Question 10

what is the most modifiable risk factor of a stroke

Answer 10

hypertension

Question 11

what areas of the brain are at particular risk of haemorrhages stroke due to small end arteries

Answer 11

basal ganglia
subcorticical areas
brainstem

Question 12

risk factors

Answer 12

stroke 2x stroke 3x subarachnoid
being male
AF
diabetes
oestrogen makes the blood sticky
lipids LDL
drinking
obesities
endocarditis

Question 13

atrial fibrillation what is the risk with stroke

Answer 13

5x risk of embolic stroke as the hearts not beating normally there is stagnant blood this can form clots and cause server strokes

Question 14

what does AF look like on the ECG

Answer 14

no p waves and messy lines

Question 15

what are the best anticoagulants

Answer 15

edoxaban apixaban

Question 16

what can happen if the frontal lobe is damaged

Answer 16

memory
motor control of the eyes
motor control of speech - brocas area
moter cortex
emotion and personality
urinary incontinence

Question 17

what can happen if the parietal lobe is damaged

Answer 17

sensation can’t identify touch pressure position
awareness of parts of the body proprioception
spatial orientation
damage of the non dominant hemispheres - right side

Question 18

what is the main function of the temporal lobe

Answer 18

primary auditory receptive area (language)

Question 19

what is damaged if there is a stroke in the temporal lobe

Answer 19

comprehension of speech - wernickes area

visual auditory and olfactory perception

important in leaning memory and emotion

Question 20

what will happen if there is stroke in the internal capsule

Answer 20

completly paralysed

Question 21

what can be effected if cerebellum stroke

Answer 21

balance and coordination

Question 22

what is hemiparesis

Answer 22

one sided muscle weakness

Question 23

what can happen if the brainstem is effected by stroke

Answer 23

10 of the 12 cranial nerves emerge from here 3-12 so IPSILATERAL damage
- eyemovement
- breathing
-heart beat
- swallowing
-consciousness

contralateral hemiparesis due to cortical tracts crossing in the medulla

Question 24

what does TACS PACS LACS AND POCS stand for in the Bamford Oxford classification of strokes

Answer 24

total anterior circulation stroke
partial anterior circulation stroke
lacunar sundrome
posterior circulation syndrome

Question 25

what is the features of total anterior circulation stroke

Answer 25

large cortical stroke effecting the anterior and middle cerebral arteries

all 3 points must be present

loss of motor in face arms and lower limbs

loss of sensory on the face arms or lower limbs

and at least 2 cortical signs

homonymous hemianopia
dysphagia left
neglect right

Question 26

what are the features of a partial anterior circulation stroke

Answer 26

weakness in arms legs face

or sensory loss in arms legs face

plus 1 cortical sign
hemianopia
dysphagia
neglect

Question 27

what are the features of posterior circulation syndrome

Answer 27

one of the following
loss of conciseness
cerebellar signs - vertigo, nystagmus ataxia
loss of consciousness
isolated homonymous hemianopia

Question 28

what is the clinical classification of the lacs

Answer 28

purely sensory and motor

Question 29

what is neglect

Answer 29

neglect usually occurs with right hemisphere

ignore the stimulus from the effected side

deny anything wrong

failure to recognise faces

Question 30

what are the investigations for stroke

Answer 30

CT or MRI scan ishchmeic or heammoragic
bloods FBC glucose lipids
ecg
carotid doppler ultrasound stenosis

Question 31

when does an initial CT scan need to be done

Answer 31

2hrs

Question 32

what are the first line medications for a stroke

Answer 32

thrombolysis tPA within 4hrs
antiplatelet aspirin 150-300 within 24-48hrs

Question 33

what is the best treatment for a patient with stroke

Answer 33

thrombolysis and throboectomy although the stroke unit has the best impact on the most people

Question 34

what is the strict criteria for thrombolysis

Answer 34

given within 4.5 hrs
have to have a serious neurological deficit
symptoms for more than a hour
consent

Question 35

what are the contradictions for thrombolysis

Answer 35

on anticoagulants like apixaban endoxiban
high blood pressure >185 systolic >110
high glucose >22mol or less than 2.8