Stroke

Question 1

What is the leading cause of long term disability?

Answer 1

stroke

Question 2

What is a stroke?

Answer 2

sudden onset neurological deficit lasting greater than 24 hours

Question 3

What is a TIA?

Answer 3

brief episode of neurological deficit caused by focal ischaemia lasting less than 24 hours (but typically much shorter) without evidence of acute infarction

Question 4

What is the difference between haemorrhage and ischaemic stroke?

Answer 4

haemorrhage - blood leaks into brain tissue

ischaemic - clot stops blood supply to an area of the brain

Question 5

What are some stroke mimics?

Answer 5

seizure 
sepsis 
SOL 
syncope 
vestibular dysfunction 
dementia

Question 6

What factors are required to make a full diagnosis of stroke?

Answer 6

type
size
laterality
cause

Question 7

How is size of stroke classified?

Answer 7

Oxford classification - TACS, PACS, LACS, POCS

Question 8

What is involved in a TACS?

Answer 8

hemiplegia of at least two of arm, face and leg
homonymous hemianopia
cortical signs - dysphasia, neglect

Question 9

What is involved in a PACS?

Answer 9

2 out of 3 features present in a TACS

isolated cortical dysfunction

Question 10

What is a LACS?

Answer 10

small infarcts in the deeper parts of the brain - basal ganglia, thalamus and brain stem

Question 11

what causes LACS?

Answer 11

caused by occlusion of a single deep penetrating artery - any two of face arm leg

Question 12

What is seen in POCS?

Answer 12

cranial nerve palsies 
bilateral deficits 
isolated homonymous hemianopia 
cortical blindness 
ataxia

Question 13

Which is the dominant hemisphere?

Answer 13

Left

Question 14

What is important about strokes affecting the dominant hemisphere?

Answer 14

often affects language

non-dominant - neglect

Question 15

What are some causes of primary intracerebral haemorrhage?

Answer 15

hypertension

amyloid angiopathy

Question 16

What are some causes of secondary intracerebral haemorrhage?

Answer 16

AVM
aneurysm
tumour

Question 17

What changes can be seen on hyperacute brain CT?

Answer 17

maybe none!

hyperdense MCA sign

Question 18

What is a red thrombus?

Answer 18

fibrin containing cardioembolic thrombus

Question 19

What is a white thrombus?

Answer 19

patelet dependent atherothrombolic thrombus

Question 20

What investigations should be done in a stroke patient?

Answer 20

full lipid profile
blood pressure
carotid scan
ECG - 24hr

Question 21

What is the ABCDD of medical stroke prevention?

Answer 21

antithrombotic therapy - antiplatelet/anticoagulant 
blood pressure 
cholesterol 
diabetes 
don't smoke

Question 22

What is a potential serious outcome of a missed diagnosis of impaired swallow?

Answer 22

aspiration pneumonia

Question 23

What is involved in the ABCD2 score?

Answer 23

age greater than 60 - 1 
blood pressure - 1 
clinical features 
-unilateral weakness - 2 
-speech disturbance - 1
-other - 0
Duration 
- >60mins - 2
- 10-59 - 1 
- <10-0 - 0
Diabetes - 1

Question 24

Name some antiplatelet agents

Answer 24

clopidogrel
aspirin
dypiridamole

Question 25

Which type of stroke is low cholesterol associated with?

Answer 25

haemorrhage stroke

Question 26

What is a carotid endarterectomy?

Answer 26

opening of the carotid arteries and removing plaques to reduce arterial stenosis and stroke risk

Question 27

What two factors are key in small vessel disease?

Answer 27

blood pressure 
blood sugar (diabetes)

Question 28

what is AF?

Answer 28

supraventricular tachyarrhythmia characterised by uncoordinated atrial activation and reduced function

Question 29

What does rivaroxaban inhibit?

Answer 29

direct factor 10a inhibitor

Question 30

What does dabigatran inhibit?

Answer 30

direct thrombin inhibitor