Stroke

Question 1

hoe long must a stroke last to be defined as stroke?

Answer 1

more that 24 hours

Question 2

give some general symptoms of stroke

Answer 2

> loss of power
> loss of sensation
> loss of speech
> loss of vision
> loss of coordination

Question 3

what is gaze palsy?

Answer 3

double vision horizontally

Question 4

what causes damage to part of the brain during a stroke?

Answer 4

blockage of blood vessel by a thrombus or embolus, or due to a haemorrhage from a ruptured blood vessel

Question 5

what does the external carotid artery supply?

Answer 5

the face

Question 6

what is unique about the basilar artery?

Answer 6

it is formed from two smaller vessels which join together

Question 7

what does the vertebral-basilar system supply?

Answer 7

the brain stem, cerebellum and occipital lobes with the posterior cerebral artery

Question 8

what does the internal carotid supply?

Answer 8

the hemispheres and cortical deep white matter

Question 9

what two arteries does the internal carotid split into?

Answer 9

the anterior cerebral and the middle cerebral

Question 10

give some causes of stroke

Answer 10

> blockage of vessel with thrombus
disease of vessel wall
disturbance of normal properties of blood
rupture of vessel wall (haemorrhage)

Question 11

what percentage of strokes at ischaemic?

Answer 11

85%

Question 12

what causes for ischaemic stroke are there?

Answer 12

> large artery atherosclerosis
> cardioembolic
> small artery occlusion
> arterial dissection (rare)
> Venous sinus thrombosis (rare)

Question 13

what percentage of strokes are haemorrhagic?

Answer 13

15%

Question 14

what causes for haemorrhagic stroke is there?

Answer 14

> primary intracerebral haemorrhage

> secondary haemorrhage

Question 15

give two examples of causes of a secondary haemorrhagic stroke

Answer 15

> subarachnoid haemorrhage

> arteriovenous malformation

Question 16

what is an ischaemic stroke?

Answer 16

a clot stops blood supply to an area of the brain

Question 17

what is a haemorrhagic stroke?

Answer 17

when blood leaks into brain tissue, there is a pressure effect on the brain

Question 18

what is the commonest cause of a cardioembolic stroke?

Answer 18

atrial fibrillation

Question 19

describe a lacunar stroke

Answer 19

the walls of a small vessel in the brain get thickened creating a smaller lumen. this occlusion creates a small area of damage. this is generally caused by hypertension.

Question 20

describe how a carotid dissection can lead to stroke

Answer 20

it can be idiopathic or due to trauma. the wall of the carotid tears and a clot then thrombus forms on top of that

Question 21

what can you tell about the stroke from the signs and symptoms of the patient?

Answer 21

> what side of the brain is affected
whether the lesion is in the brainstem (brainstem stroke)
whether the cortex is involved (cortical stroke)
if the lesion is in the white matter (lacunar stroke)
what blood vessel is involved

Question 22

what is TACS?

Answer 22

total anterior circulation stroke

Question 23

what is PACS?

Answer 23

partial anterior circulation stroke

Question 24

what is LACS?

Answer 24

lacunar stroke

Question 25

what is POCS?

Answer 25

posterior circulation stroke

Question 26

give an example of a lesion that would cause unilateral field loss of vision?

Answer 26

left optic nerve compression

Question 27

what lesion would cause bitemporal hemianopia?

Answer 27

chiasmal compression from the pituitary tumour

Question 28

what lesion would cause homonymous hemianopia?

Answer 28

left cerebrovascular event

Question 29

what would you expect to see in a patient with a total anterior circulation stroke?

Answer 29

> weakness > sensory defect > homonymous hemianopia > higher cerebral dysfunction

Question 30

what would you expect to see in a partial anterior circulation stroke?

Answer 30

2/3 of the TACS criteria or restricted motor/sensory deficit

Question 31

what four types of stroke can a lacunar stroke create?

Answer 31

> pure motor > pure sensory > sensorimotor > ataxic hemiparesis

Question 32

what is a sensorimotor lacunar stroke?

Answer 32

a combination of a sensory and motor stroke

Question 33

describe an ataxic hemiparesis lacunar stroke

Answer 33

> hemiparesis and ipsilateral cerebral ataxia. > small infarcts in basal ganglia or pons > intrinsic disease of single basal perforating artery

Question 34

what will a posterior circulation stroke affect?

Answer 34

the brainstem, cerebellar or occipital lobes

Question 35

what are some modifiable risk factors for stroke?

Answer 35

> high blood pressure | > atrial fibrillation

Question 36

what investigations would you carry out for stroke?

Answer 36

``` > full blood count > ECG > CT scan > MRI scan > carotid doppler ```

Question 37

what is the aim of thrombolysis?

Answer 37

to restore perfusion before cell death occurs

Question 38

how many neurons will a typical patient lose very minute a stroke is not treated?

Answer 38

1.9million

Question 39

what are the risk factors for haemorrhage after thrombolysis?

Answer 39

``` > infarct size > vessel occlusion > diabetes > blood pressure > age > stroke severity > tissue changes > anti-platelets ```

Question 40

what should you do is a patient has an ongoing neurological deficit that came on less than 4.5 hours ago?

Answer 40

arrange an urgent CT scan then contact the stroke bleep via switchboard

Question 41

what are the contraindications to thrombolysis?

Answer 41

``` > age > over 80yr > MI > recent bleeding > very high blood pressure ```

Question 42

what is the mortality of malignant MCA infarction?

Answer 42

up to 80%

Question 43

when should surgical decompression by hemicraniectomy be offered?

Answer 43

in individuals up to 60 years who suffer an acute MCA territory ischaemic stroke complicated by a mass cerebral oedema

Question 44

how many people that suffer a TIA will have an acute stroke in the future?

Answer 44

one third

Question 45

in TIA what is associated with a reduced risk of subsequent stroke?

Answer 45

evaluation and initiation of treatment in a specialised outpatient clinic.

Question 46

describe secondary prevention of stroke

Answer 46

> clopidogrel or aspirin > statin > blood pressure drugs (even if it is normal)