Stroke

Question 1

What is a stroke?

Answer 1

Acute onset of focal neurological symptoms and signs due to disruption of blood supply

Question 2

What organs can be affected by a stroke?

Answer 2

Brain, spinal chord and eyes

Question 3

What are the two different types of stroke?

Answer 3

Ischemic (80%)

Hemorrhagic (20%)

Question 4

What is an ischemic stroke?

Answer 4

When a clot blocks blood flow to an area of the brain

Question 5

What is a hemorrhagic stroke?

Answer 5

When bleeding occurs inside or around brain tissue due to a torn vessel

Question 6

What are the risk factors to a hemorrhagic stroke?

Answer 6

Hypertension
Weakened blood vessels due to structural abnormalities such as an aneurysm or AVM or inflammation of the vessel walls (vasculitis)

Question 7

What is hypoperfusion?

Answer 7

Reduced blood flow due to a stenosed artery rather than an occluded artery

Question 8

What are the non-modifable risk factors for a stroke?

Answer 8

Age
Family history of vascular disease 
Gender
Race
Previous stroke

Question 9

What are the modifiable risk factors for stroke?

Answer 9

Hypertension 
Hyperlipidaemia
Smoking
Prior history of TIA 
AF
Diabetes
CHF
Alcohol excess
Obesity 
Physical inactivity

Question 10

What are some causes of stroke in younger people with minimal risk factors?

Answer 10

Homocysteinemia
Vasculitis, antiphospholipid antibody syndrome
Protein S, C, antithrombin 3 deficiency
Paradoxial embolism
Genetic
Cardioembolic (mural thrombi, infective endocarditis, myxoma)
Cervial artery dissection

Question 11

What are the 4 questions to think when investigating a stroke?

Answer 11

Is it a stroke?
What kind of stroke it is?
What caused the stroke?
Is the patient receiving appropriate secondary prevention following investigations?

Question 12

What are conditions that a stroke can mimic?

Answer 12

Hypoglycaemia
Seizure (postictial states) 
Migraine
Other metabolic - hyperglycaemia, hyponatremia
Space occupying lesions (brain tumour) 
Functional hemiparesis

Question 13

What is the only way to differentiate between an ischaemic and haemorrhagic stroke?

Answer 13

Brain imaging - CT brain, MRI

Question 14

What investigations are needed if it is an ischaemic stroke?

Answer 14

Find cause of thrombus or embolism

Blood tests - glucose, lipids, thrombophilia, hypertension

Question 15

Where will an atheroembolism travel to?

Answer 15

An embolism from a thrombus forming on an atherosclerotic plaque will infarct in the same side as the effected carotid artery

Question 16

Where will a cardioembolism travel to?

Answer 16

An embolism from a clot formed in the heart (usually the left atrium) will infarct in more than one arterial territory and could result in a bilateral clot

Question 17

What investigations should be undertaken if a haemorrhagic stroke is suspected?

Answer 17

Investigate cause of bleeding (imaging)
Hypertensive - usually deep in brain
If young, not hypertensive and lobar (superifical) haemorrhage then investiage for aneurysm or AVM
If multiple haemorrhages then investigate for vasculitis

Question 18

What medical management is given after an atheroembolic stroke?

Answer 18

Antiplatelets (aspirin, dipyridamole or clopidogrel) 
Statins 
Diabetes
Hypertension management 
Lifestyle advice

Question 19

What is a TIA?

Answer 19

Temporary neurological symptoms due to occlusion of an artery stopping blood flow - it is temporary because arteries are capable of dissolving small clots