Stroke

Question 1

What is a stroke?

Answer 1

When the blood flow to part of the brain is cut off. All organs of the body need oxygen which is carried in the blood and every part of the brain needs a good blood supply in order to function.
Stroke has a rapid onset, causes a neurological deficit and is vascular in origin.
Abrupt loss of focal brain function lasting over 24hrs
Includes SAH

Question 2

What are the main types of stroke? and which is more common?

Answer 2

Ischaemic (most common) - Blood supply is stopped by a blot clot and the arteries are often narrowed due to atherosclerosis
Haemorrhagic - weakened blood vessel bursts. Main cause is hypertension which weakens the artery walls

Question 3

What are the risk factors for stroke?

Answer 3

Smoking
High BP
Obesity 
High cholesterol 
Diabetes 
Excessive alcohol use 
Atrial Fibrillation
Age 
Gender 
Family History of Stroke

Question 4

What is the treatment for stroke?

Answer 4

Warfarin - reduces chance of clot occurring again (affects synthesis of vitamin K dependent clotting factors - ii, vii, ix, x)
Antihypertensives to treat high BP
Statins to lower cholesterol
Thrombolysis - altepase, streptokinase –> dissolves blood clots and restores flow of blood to the brain
haemorrhagic stroke - surgery to repair ruptured blood vessels

Question 5

What lifestyle advice can be given?

Answer 5

Eat a healthy diet, stop smoking and reduce alcohol

Question 6

What are the causes for cerebral infarcts?

Answer 6

Large vessel atheroma/embolism
cardiac embolism
Small vessel disease
Blood disorders

Question 7

What are the causes of a intracerebral haemorrhage?

Answer 7

Hypertensive microaneurysms 
Arteriovenous Malformations 
Amyloid angiopathy
Haemostatic anticoagulant 
Cocaine 
Amphetamines 
Tumour 
Venous thrombosis

Question 8

What is Brocas aphasia?

Answer 8

Comprehension fine
Struggle to speak
When stroke is in frontal lobe

Question 9

What is wernickes aphasia?

Answer 9

Speaks very fast but is incomprehensible
cannot do 3 stage command
when there is damage to temporal lobe

Question 10

What can a stroke in the cerebellum cause?

Answer 10

D - Dysdiadokinesia 
A - Ataxic gait 
N - nystagmus
I - Intention tremor 
S - Slurred/Staccato speech 
H - Hypotonia

Question 11

What is a TIA?

Answer 11

Transient Ischaemic Attack - sudden onset, focal disturbance of brain function (occasionally global)

Question 12

What are some differential diagnoses for stroke?

Answer 12

Hypoglycaemia 
Migraine aura
Epilepsy 
SOL
MS - demylination

Question 13

List some symptoms of stroke

Answer 13

one side of the body weakness 
facial droop on one side 
slurred speech 
dizziness 
confusion 
loss of consciousness

Question 14

What additional symptoms may also be present?

Answer 14

Headache, seizures - suggest bleeding
Headache, vomiting, drowsiness - suggest raised ICP
Cardiac symptoms - suggests aetiology

Question 15

Which part of the brain does the anterior cerebral artery supply?

Answer 15

the medial part of the frontal and parietal lobes

anterior portion of the corpus callosum, basal ganglia and internal capsule

Question 16

Which part of the brain does the middle cerebral artery supply?

Answer 16

Lateral part of the cerebrum
lateral aspect of the frontal, parietal and occipital lobes
Most strokes occur in this territory

Question 17

Which artery joins to the two anterior cerebral arteries?

Answer 17

the anterior communicating artery

Question 18

Which artery does the vertebral artery arise from?

Answer 18

Subclavian arteries

Question 19

Which branch is the largest branch of the Vertebral arteries?

Answer 19

Posterior inferior cerebellar artery (PICA)

Question 20

Which part of the brain does the basilar artery supply?

Answer 20

Most of the brainstem
Overlies the pons
Stroke here has poor prognosis

Question 21

Which part of the brain does the posterior cerebral artery supply?

Answer 21

Goes around the midbrain

Supplies midbrain, thalamus, temporal and occipital lobes

Question 22

What does a normal early CT scan rule out if a patient presents with symptoms of a stroke?

Answer 22

Rules out bleeding

DOES NOT rule out infarct or ischaemic stroke

Question 23

When should thrombolysis be given?

Answer 23

Within 3hr of documented event
CT must exclude bleeding and established infarct
No bleeding risk (i.e. not on warfarin)