Stroke

Question 1

What are the clinical features of stroke?

Answer 1

• sudden onset
• focal neurological deficit
• symptoms lasting more than 24 hrs

*symptoms for less than 24hrs is a TIA transcient ischaemic attack

Question 2

What are the 2 types of stroke diagnosis?

Answer 2

• Cerebral Infarction

- Cerebral Haemorrhage

Question 3

What is the pathophysiology of acute ischaemic stroke?

Answer 3

1) reduction of cerebral blood flow
2) Ischaemia causes alterations in cellular chemistry
3) Cellular necrosis

Question 4

How much glucose does the bran use per day?

Answer 4

125 g / day

Question 5

What are the causes of ischaemic stroke?

Answer 5

1) thrombosis

2) Emboli (from heart or from nearby arteries)

Question 6

What is the most common mechanism of ischaemic stroke?

Answer 6

Large vessel atherosclerosis

Question 7

What are some treatments for secondary stroke prevention?

Answer 7

-Aspirin (anti-coagulant)

Question 8

What are is the impact of re-canalization on ischaemic stroke outcome?

Answer 8

Early recanalisation is strongly associated with improved functional outcome and reduced mortality

Question 9

What is a TIA (transcient Ichaemic Attack)?

Answer 9

TIA is neurological deficit lasting less than 24hours attributable to cerebral or retinal ischaemia

Question 10

how long do most TIAs last?

Answer 10

60 mins

Question 11

What are the causes of TIAs?

Answer 11

Causes of TIAs and the same as stroke.

1) Atherosclerosis (large arteries)
2) small cerebral vessel disease.
3) cardiac emboli

Question 12

What conditions does TIA / stroke mimic?

Answer 12

• siezures
• syncope
• hypoglycaemia
• migraine
• confusion

Question 13

What are the characteristics of an anterior circulation TIA / stroke ?

Answer 13

• Dysphasia (inability to generate speech)
• Apraxia (inability to perform planned action)
• Inattention
• amarausis fugax (monocular or binocular vision loss)

Question 14

What are the characteristics of a posterior cirulation TIA / stroke?

Answer 14

• Ataxia (the loss of full control of bodily movements)
• Diplopia (double vision)
• Vertigo (feel like they are swaying)
• Bilateral Symptoms

Question 15

What circulatory problems are associated with :

• visual fields disturbances
• Hemiparesis (weakness of one side of body)
• Hemisensory loss
• Dysarthria (difficult articulation of speech)

Answer 15

Either circulation

internal carotid or vertebral

Question 16

Combination of what drugs reduces risk of vascular events by 80%

Answer 16

1) Statin
2) Aspirin
3) Antihypertensives
4) Folic Acid

Question 17

Damage to what area causes difficulty finding words and have a stilted flow of speech?

Answer 17

Broca’s area

damage to broca’s area causes expressive dysphagia

Question 18

Damage to what area causes fluent speech but made up words and mistaken use of words?

Answer 18

Wernicke’s area

Question 19

Blood pressure (rises after stroke but settles after a few days) In what situations should hypertensives be given?

Answer 19

1) intracerebral haemorrhage
2) Hypertensice encephalopathy, nephropathy / cardiomyopathy.
3) Aortic dissection
4) Eclampsia / Pre-eclampsia

Question 20

When should oxygen be supplied after a stroke?

Answer 20

If saturations fall below 95% give oxygen

Question 21

What parameters should glucose be controlled between after a stroke?

Answer 21

4 - 11 mmol/L

Avoid hypoglycaemia

Question 22

What are the complications that stroke patients can experience in hospital?

Answer 22

1) Aspiration of food causing infection in lungs (difficulty swallowing so NG tube)
2) Deep Vein thrombosis (immobility and sepsis are risk factors)
3) Pressure Ulcers (risk factors : immobility, malnuitrition, diabetes)

Question 23

What hemisphere stroke is neglect a feature of?

Answer 23

Right hemisphere

*neglect is the failure to attend to / monitor left side.

Question 24

What is Agnosias?

Answer 24

the inability to recognise a common object by one sense alone