Stroke

Question 0

two main types of stroke

Answer 0

Ischaemic stroke *85%

Haemorrhagic (inc SAH)

Question 1

definition of stroke

Answer 1

neurological deficit related to an atraumatic vascular event

Question 2

what events are NOT included in the current definition of stroke

Answer 2

Extradural haematoma

Subdural haematoma

Question 3

what is a TIA

Answer 3

neurovascular event with symptomatic resolution within 24 hours

Question 4

what are the cardinal features of stroke?

Answer 4

FOCAL
NEGATIVE
ACUTE
obey arterial territory –> if > 3 territories unlikely to be a stroke

Question 5

what is the cushing’s reflex

Answer 5

sudden increase in systemic blood pressure and decrease in heart rate in response to an increase in intracranial pressure

Question 6

What is todd’s paresis?

Answer 6

After seizure weakness

Question 7

What is the significance of crossed signs after a stroke

Answer 7

It indicates that there is injury to the brainstem

Question 8

What is amaurosis fugax?

Answer 8

The sensation of a “curtain coming down” in one eye. It is indicative of micro embolism in the retinal circulation

Question 10

What does papilloedema show?

Answer 10

That there has been a gradual increase in ICP as in a venous cerebral event such as CVST

Question 11

what are the features of an extradural haemorrhage

Answer 11

lentiform appearance on imaging
follows linear skull vault fractures, usually affecting middle meningeal artery
patient presents with euro signs after a lucid interval
surgery is often indicated

Question 12

what are the features of a subdural haemorrhage

Answer 12

crescent shape on CT/MRI
acute hyper dense
chronic hypodense
accumulation of blood in the subdural space following the rupture of a vein

Question 13

what is ABCDD

Answer 13

risk of two day recurrent stroke risk based on:

• age
• blood pressure
• clinical features
• duration
• diabetes

Question 14

what would defect in anterior cerebral artery show

Answer 14

weak leg (+/-shoulder) on contralateral side

Question 15

what would defect in middle cerebral artery show

Answer 15

weak arm and face on contralateral side:

• hemiplegia
• hemianopia
• aphasia
• visuospatial problems

Question 16

what would defect in the posterior cerebral artery show

Answer 16

eye problems

Question 17

what is the presentation of cerebral haemorrhage

Answer 17

as with ischaemic stroke but with

• sudden onset headache
• sudden and progressive neuro defects
• most likely to lose consciousness
• raised ICP –> cushion’s (late)

Question 18

what is the presentation of subarachnoid haemorrhage

Answer 18

sudden headache and vomiting
meningism
LoC

Question 19

what is the presentation of CVST

Answer 19

subacute raised ICP –> papilloedma can develop

• younger pts w/DVT risk factors
• no respect for arterial territories
• absence of sinuses on venograms

Question 20

what is the criteria for thrombolysis in stroke

Answer 20

must be ischaemic stroke
within 3 hrs
must be stable and no risk factors for intra-cranial haemorrhage

Question 21

on CT what do hyper dense vessels suggest

Answer 21

thrombus if localised

if all bright –> increased haematocrit

Question 22

what is more accurately seen (in the case of stroke) on CT

Answer 22

thrombus

Question 23

what does the loss of normal grey white differentiation of head CT suggest

Answer 23

early infarction

gets darker late

Question 24

what is head MRI good for in the context of stroke

Answer 24

small infarcts

Question 25

atherosclerosis of the lenticulostriate arteries causes what

Answer 25

lacuna infarction | associated with chronic hypertension

Question 26

where is venous infarction likely to haemorrhage

Answer 26

at the top of the brain

Question 27

what is Charcot-Bouchard aneurysms

Answer 27

aneurysms of microvasculature associated with chronic hypertension causes vascular coiling often in lenticulostriate arteries

Question 28

where are the common sites for Berry aneurysms

Answer 28

between PCA and ICA between anterior communicating and ACA at the bifurcation of the MCA

Question 29

what are Berry aneurysms associated with

Answer 29

coarctation of the aorta polycystic kidney disease renal artery stenosis

Question 30

what is the average cerebral blood flow

Answer 30

50mls/100g/min accounts for 20% of resting CO

Question 31

what does profound hypotension cause in the context of cerebral iaschaemia

Answer 31

inadequate CBF for metabolic needs impaired cellular metabolism decreased neuronal activity

Question 32

autoregulation maintains CBF at what pressure

Answer 32

between 50-150mmHg

Question 33

what can impair auto regulation in the brain

Answer 33

``` increasing age head trauma SAH ischaemic stroke cerebral hypoxia high pCO2 ```

Question 34

which cells are most vulnerable to hypoxic injury in the brain

Answer 34

pyramidal cells in the hippocampus and purkinje cells of the cerebellum

Question 35

what is laminar necrosis

Answer 35

loss of layers of neurones following global ischaemia

Question 36

what is penumbra

Answer 36

area of oedematous cells around the dead cells which have the potential to be saved

Question 37

how is oedema caused in hypoxia

Answer 37

hypoxia causes failure of the NaKATPase leading to XS Na water follows Na into the cell cells burst and die this can also increased ICP this can intern reduce blood supply to the brain

Question 38

besides hypoxia, what else causes intracellular accumulation of Na in the brain

Answer 38

continued depolarisation of neutrons in the affected area caused by cessation of ATP dependant reuptake of glutamate this is call EXCITIOXICITY

Question 39

what does excitotoxicity cause in the brain following stroke

Answer 39

failure of AMPA and NMDA receptors - -> Ca levels in cells are excessive: - release of free radicals -> necrosis - inflammatory cytokines - Ca also causes apoptosis in the penumbra

Question 40

which clinical signs are most likely to present in an anterior circulation infarct

Answer 40

``` aphasia/dysphasia hemiparesis amaurosis fugax sensory loss hemianopic visual loss ```

Question 41

which clinical signs are most likely to present in a posterior circulation infarct

Answer 41

``` diplopia, vertigo, vomiting chocking/dysarthria hemianopic visual loss sensory loss transient glocal amnesia tetraparesis ```