Stroke

Question 1

What is stroke?

Answer 1

Sudden loss of neurological function that lasts more than 24 hours, it is of vascular origin and occurs suddenly

Question 2

Was is transiet ischaemic attack TIA ?

Answer 2

Sudden loss of neurological function that lasts less than 24 hours, it resolves itself, sometimes it is called mini stroke

Question 3

What are the symptoms of stroke ?

Answer 3

loss of power, sensation, speech, difficulty speaking, inability to comprehend language, loss of vision, coordination, headache, vertigo, various levels of consciousness

Question 4

What are the signs of stroke on examination?

Answer 4

Motor weakness or clumsy lims, loss of sensory feelings, dysarthria, dysphasia, visuospatial problems, loss of vision, hemianopia, gaze, palsy, ataxia, incoordination, nystagmus

Question 5

What is dysarthria ?

Answer 5

Speech disorder, inability to formulate the words, disturbance of muscular control

Question 6

What is dysphasia/aphasia?

Answer 6

Inability to comprehend or formulate language

Question 7

What is hemianopia?

Answer 7

It is loss of one half of visual field

Question 8

What is nystagmus?

Answer 8

Uncontrolled and uncoordinated movement of eyes

Question 9

What is ataxia?

Answer 9

Group of disorders that control coordination, speech and balance

Question 10

What are the two mains types of stroke?

Answer 10

Ischaemic or haemorrhagic

Question 11

What does cause ischaemic stroke?

Answer 11

Embolus or thrombus, large artery atherosclerosis, AF, cryptogenic, aortic dissection, venous sinus thrombosis

Question 12

What does cause haemorrhagic stroke?

Answer 12

Rupture of blood vessel that can occur due to aneurysm, hypertension or congenitally weak vessels

Question 13

What is the difference between ischaemic and haemorrhagic stroke on CT?

Answer 13

Ischaemic stroke looks dark, whereas haemorrhagic looks white

Question 14

What is penumbra ?

Answer 14

Sleep area rather than dead, there is reduced delivery of O2, but not complete absence, it is still viable tissue and it can be saved

Question 15

Describe the anterior circulation of the brain

Answer 15

Formed from common carotid artery that then forms internal artery, middle cerebral and anterior cerebral artery

Question 16

Describe the posterior circulation of the brain

Answer 16

Formed from vertebral arteries that then form basil arteries, then posterior cerebral and cerebellar artery

Question 17

Where does anterior and posterior circulations join?

Answer 17

At the Circle of Willis

Question 18

Which two arteries does Circle of Willis join?

Answer 18

Posterior cerebral and middle cerebral arteries

Question 19

What does the carotid system supply?

Answer 19

most of hemispheres, cortical deep white matter

Question 20

What does the vertebro-basillar system supply?

Answer 20

brain stem, cerebellum, occipital lobe

Question 21

Where is motor cortex?

Answer 21

In front of central sulcus, sends motor information

Question 22

Where is sensory cortex?

Answer 22

Behind the central sulcus, receives sensory information, such as pain, heat, other sensations

Question 23

Where is frontal lobe and what is its role?

Answer 23

Frontal portion of the brain, it has Broca’s speech area, judgement, foresight, voluntary movement, smell

Question 24

Where is parietal lobe and what is its role?

Answer 24

Behind the sensory portion, it is responsible for comprehension of language

Question 25

Where is occipital lobe and what is its role?

Answer 25

At the back of the brain, its role is vision

Question 26

Where is temporal lobe and what is its role?

Answer 26

Middle portion of the brain, intellectual and emotional functions, there is also Wernicke's area which has speech comprehension role

Question 27

What is the role of cerebellum?

Answer 27

Coordination

Question 28

What is the role of brainstem?

Answer 28

swallowing, breathing, other involuntary functions

Question 29

Which artery is the most likely affected if the parent can't move their upper body but can move legs?

Answer 29

Middle cerebral artery

Question 30

What are the 4 main subtypes of stroke?

Answer 30

Total anterior circulation, partial anterior circulation, lacunar stroke, posterior circulation stroke

Question 31

What is unilateral loss of vision?

Answer 31

Full loss of vision in one eye, the lesion must be close to the eye, example is optic nerve compression

Question 32

What is bitemporal hemianopia?

Answer 32

Loss of the outer fields of vision in both eyes, the lesion is in chiasmata crossover

Question 33

What is homonymous hemianopia?

Answer 33

If the right or left field of vision is lost, due to right or left cerebrovascular event

Question 34

What is TACs and what are the signs?

Answer 34

Total anterior circulation stroke, the signs include weakness, sensory deficit, homonymous hemianopia, higher cerebral dysfunctions such as dysphasia, dyspraxia

Question 35

Where does the occlusion occurs on the TACs?

Answer 35

In the internal carotid, middle cerebral

Question 36

What is PACs and what are the sings?

Answer 36

Partial anterior circulation stroke, restricted motor/sensory deficit or higher cerebral dysfunctions

Question 37

Where does the occlusion occurs in PACs?

Answer 37

In the branches of middle cerebral artery

Question 38

What is LACs and what are the signs?

Answer 38

Lacunar stroke, pure motor weakness, complete or incomplete, on one side, involving whole 2 or 3 body areas, or pure sensory with the same distribution, or sensorimotor, combination of the two, ataxic hemiparesis

Question 39

Where does the occlusion occurs in LACs?

Answer 39

In the basal ganglia or pons

Question 40

What is ataxia and hemiparesis?

Answer 40

Ataxia -lack of voluntary coordination, hemiparesis - weakness of one side

Question 41

What is POCs and what are the signs?

Answer 41

Posterior circulation stroke, affects brainstem, cerebellum, occipital lobe, very variable and complex presentation, visual problems, disordered conjugate eye movements, coma, disordered breathing, vetigo, Horners syndrome, tinnitus

Question 42

Where does the occlusion occur in POCs?

Answer 42

In the posterior circulation

Question 43

What is tinnitus ?

Answer 43

Hearing voices from the inside

Question 44

What are the risk factors for stroke?

Answer 44

hypertension, AF, cocaine use, age, race, family history

Question 45

What investigations would be performed?

Answer 45

Bloods (fBC, lipids, ESR), ECG, CT or MRI, carotid dropler, ECHO possible later on

Question 46

Compare and contrast CT and MRI machine

Answer 46

CT shows blood better, whereas MRI shows better ischaemia, but MRI takes longer time

Question 47

What scale is used to asses severity of stroke and how many stages are there?

Answer 47

NIHSS, there are 0-42 stages

Question 48

Until what time thrombolysis is acceptable to be used ?

Answer 48

Within 4.5 hours from the onset of symptoms

Question 49

What fibrinolytic agent is used for fibrinolysis ?

Answer 49

Alteplase, IV

Question 50

What are the contraindications for use of fibrinolysis ?

Answer 50

Under 16 and over 80, major infarct, haemorrhage, recent birth, trauma, surgery, artery or venous puncture at incompressible site, past CNS bleeds, hypertension, aneurysm, liver disease, varicose, portal hypertension, INR >1.7

Question 51

What is the more invasive treatment option for ischaemic stroke?

Answer 51

endovascular clot retrieval

Question 52

What is the secondary prevention for ischaemic strokes?

Answer 52

aspirin or clopidogrel, statins, BP medication, carotid endarectomy

Question 53

What is the treatment of haemorrhages stroke?

Answer 53

Surgery