Stroke.

Question 1

How common a cause of death is a stroke?

Answer 1

3rd commonest. First stroke rarely kills just causes disability.

Question 2

What two types of strokes are their and their prevalence?

Answer 2

Haemorrhagic (15-20%) and Ischaemic (80-85).

Question 3

What causes a haemorrhagic stroke?

Answer 3

Raised Bp and weakened vessels wall due to things like an aneurysm AVM or vasculitis.

Question 4

What different types of Ischaemic stroke do we get?

Answer 4

Thrombotic, embolis and hypoperfusion.

Question 5

What are the five main non modifiable risk factors for a stroke?

Answer 5

Age, family history, gender, race or previous stroke.

Question 6

What are the potentially modifiable risk factors for a stroke?

Answer 6

Hypertension, prior TIA, hyperlipidaemia, smoking, diabetes, AF, CHF, alcohol excess, obesity, physical inactivity and poor socioeconomic status.

Question 7

What therapy is recommended for Ischaemic stroke but not haemorrhagic?

Answer 7

Statins.

Question 8

What are some rare causes of stroke?

Answer 8

Vasculitis, antiphospholipid antibody syndrome, paradoxical embolism, cervical artery dissection etc.

Question 9

What can mimic a stroke?

Answer 9

Hypoglycaemia, seizure, migraine, other metabolic things like hyponutraemia. Space occupying lesion and functional hemiparesis.

Question 10

What are we looking for on examination?

Answer 10

AF, signs of cardiac failure and neurological examination findings.

Question 11

What is the only way to differentiate between types of strokes?

Answer 11

Brain imaging.
CT of the brain +/- angiography.
MRI.

Question 12

What investigations do we do to differentiate between different types of Ischaemic strokes?

Answer 12

Glucose, lipids and thrombophilia screen in young patients.
For Atheroembolism - carotid scanning, CT/MR angiography of aortic arch.
Do ECG for AF and causes of AF such as hypertension.
Echo to look for inter atrial connections.
24 hour 5 day ECG for for paroxysmal AF.

Question 13

What pattern do atheroembolisms follow?

Answer 13

Infarcts the same side as the effected carotid.

Question 14

What pattern do cardioembolisms show?

Answer 14

Infarcts in more than one arterial territory.

Question 15

How do we investigate a haemorrhagic stroke?

Answer 15

Investigate for the cause of the bleeding by imaging.

Looks for aneurysms, hypertension, AVM.

Question 16

What is a TIA?

Answer 16

Focal neurological symptoms that resolve within 24 hours, but MRI changes can be seen with symptoms of over 1 hour.

Question 17

What is the outcome of thrombolysis according to studies?

Answer 17

Increases chance of symptomatic bleed within 36 hours but is associated with a better functional outcome.

Question 18

What is the medical management of a patient following a stroke?

Answer 18

Aspirin 75mg and 
dipyridamole MR 200mg twice daily or clopidogrel 75 mg per day.
Statins
Anticoags if in AF.
Anti hypertensives important.

Question 19

What different surgical interventions do we use for stroke?

Answer 19

Haematoma evacuation. Relief of raised ICP. carotid endartectomy.

Question 20

What is the definition of a stroke?

Answer 20

Acute onset of focal neurological symptoms and signs. Due to disruption of blood supply. It is an end organ complication of poor vascular health.

Question 21

What can we look for to see if there has been a previous stroke?

Answer 21

Haemosiderin deposits.

Question 22

What should we look for if we see multiple bleeds in a stroke?

Answer 22

look for vasculitis, Moyà Moyà disease and cerebral amyloid.