Stroke

Question 1

Haemorrhage in the brain could be due to…

Answer 1

1. Congenital weakness
2. Aneurysm
3. Hypertension

Question 2

Brain circulation

Answer 2

Anterior circulation
Posterior circulation
Circle of Willis

Question 3

Frontal lobe

Answer 3

Judgement, foresight, voluntary movement, smell

Question 4

Broca’s area

Answer 4

Speech

Question 5

Temporal lobe

Answer 5

Intellectual and emotional functions. Hearing

Question 6

Brainstem

Answer 6

swallowing, breathing, heartbeat, wakefulness centre and other involuntary functions

Question 7

Cerebellum

Answer 7

Coordination

Question 8

Wernicke’s area

Answer 8

Speech comprehension

Question 9

Occipital lobe

Answer 9

Primary visual inspection

Question 10

Parietal lobe

Answer 10

Comprehension of language

Question 11

Sensory cortex

Answer 11

Pain, heat and other sensations

Question 12

Motor cortex

Answer 12

movement

Question 13

Types of stroke causes

Answer 13

1. Ischaemic stroke (85%)

2. Haemorrhage stroke (15%)

Question 14

Modifiable Risk factors for stroke

Answer 14

High BP

AF

Question 15

Non-modifiable risk factors for stroke

Answer 15

Age
Race
Family history

Question 16

Risk factors for haemorrhage after stroke

Answer 16

Infarct size
Vessel occlusion
Diabetes
Blood pressure
Age
Stroke severity 
Tissue changes
Antiplatelets

Question 17

How you can cause harm to someone with a stroke

Answer 17

Alteplase: fibrinolytic agent
Cause unexpected bleeding either in the brain if the tissue has established damage
If brain tissue is already dead then restoring blood supply isn’t going to help
Or bleeding elsewhere

Question 18

SIGN guidelines for thrombolysis

Answer 18

Patients admitted with stroke within 4.5 hours of definite onset of symptoms who are suitable should be treated with IV rt-PA
Onset to treatment time should be minimised
Systems should be optimised to allow earliest possible delivery of IV rt-PA within the defined time window
Streptokinase SHOULD NOT be used in acute phase of stroke
Thrombolysis should be administered within the context of an acute stroke
Local protocols for the administration of thrombolytic therapy should be developed

Question 19

Contraindications to thrombolysis

Answer 19

Minor neurological deficit or symptoms rapidly improving
Symptoms of ischaemic attack >4 hours prior to referral or when the time of onset is unknown
Severe stroke as clinically assessed or/and by imaging
Seizure at onset of stroke
Symptoms suggestive of an arachnoid haemorrhage even if CT is normal
On warfarin or administration of heparin in the last 48 hours and thromboplastin time exceeding the upper limit for normal laboratory
History of prior stroke or concomitant stroke
Prior stroke in last 3 months
Platelet count <100,000m3
Systolic blood pressure >185mmHg or is diastolic blood pressure >100mmHg or aggressive IV medication needed to reduce BP limits
Blood glucose <3 or >20mmol/L
Known haemorrhagic diathesis. manifest or recent severe or dangerous bleeding, known history of suspected intracranial haemorrhage
Age = most RTCs have excluded under 16s and over 80s. Licence limited under 80 yrs
MI; recent bleeding; very high BP etc

Question 20

Acute stroke treatments

Answer 20

Stroke unit
Thrombolysis 0-3hrs
Aspirin 0-48hrs
Hemicrainectomy 0-48hrs

Question 21

Importance of stroke units

Answer 21

Mobilise ASAP
Concentrate on simple things like swallowing, positioning etc
Early therapy
Concentrating of expertise

Question 22

Secondary prevention of stroke

Answer 22

Urgent assessment and treatment of TIA and minor stroke
Clopidogrel 75mg/Aspirin 75mg plus dipyridamole MR 200mg bd
Statin
Blood pressure drugs even if BP is in normal range
Carotid endarectomoy

Question 23

Clinical symptoms of a stroke

Answer 23

Dead numbness
Loss of vision 
Loss of speech (comprehension or fluid of speech)
Loss of power
Loss of sensation
Loss of coordination

Question 24

Stroke subtypes

Answer 24

TACS
PACS
LACS
POCS

Question 25

Investigations for stroke

Answer 25

Blood test; FBC, lipids
ECG
Imaging: CT, MRI, Carotid Doppler. Sometimes ECHO for if there is a clot in the heart