Stroke

Question 1

What is stroke?

Answer 1

When blood supply to part of the brain is suddenly disrupted either by a blockage of the artery or by bleeding within the brain causing damage to brain cells

Question 2

What are the main causes of ischemic stroke? (3)

Answer 2

Due to reduction or complete blockage of blood flow by:

1. Thrombosis
2. Embolisation
3. Lacunar infarction from small vessel disease

Question 3

What is the penumbra?

Answer 3

Cells around the infarct that receive less oxygen and glucose but can recover if blood flow is returned

Question 4

What are the 2 types of haemorrhagic stroke?

Answer 4

1. Intracranial hemorrhage (ICH)
   Damages the brain directed at the site of haemrrhage by compressing the surrounding tissue
2. Subarachnoid haemorrhage (SAH)
   Bleeding in the cerebrospinal fluid within the subarachnoid space that surrounds the brain.

This increases pressure in the brain hence killing the cells in the area

Question 5

What acronym is used to identify a stroke?

Answer 5

FAST

Facial weakness
Arm weakness
Speech difficulty
Time to act

Question 6

Acute management of a haemorrhage stroke?

Answer 6

Medical management
- Reverse anticoagulants
- Manage BP
Surgical management
- Transfer to neurosurgery department

Question 7

Acute management of ischemic stroke?

Answer 7

Depending on time of onset
<4.5 hours Give alterplase
If alterplase cant be given: 150-300mg aspirin then 100mg daily thereafter

Question 8

How would you determine whether a stroke is haemorrhage or ischemic?

Answer 8

CT scan

Question 9

What is the MOA of alterplase?

Answer 9

Recombinant tissue plasminogen activator

It converts plasminogen to plasmin which catalyses the breakdown of fibrin

Question 10

When should blood pressure be dropped in ischemic stroke?

Answer 10

When BP > 220/110
should be drop no more than 10-20%

GTN patch is favourable as it can be removed at anytime

Question 11

What lifestyle changes can lower the risk of a secondary stroke? (4)

Answer 11

1. Quit smoking
2. Healthy eating
3. Avoid excessive alcohol
4. Obesity

Question 12

What secondary prevention measure can be taking to reducing the risk of stroke?

Answer 12

1. BP management
2. Cholesterol management
3. Antiplatelet therapy
4. Atrial fibrillation- measure CHADS2 score to determine the need of an anticoagulant