Stroke

Question 1

which is the most common type of stroke?

Answer 1

ischaemic (80-90%)

haemorrhagic is only 10-20%

Question 2

TIA - clinical effects will resolve within?

Answer 2

24 hours

Question 3

what usually causes a TIA ?

Answer 3

micro emboli

Question 4

what is hemiparesis ?

Answer 4

weakness

Question 5

most common stroke involves what artery?

Answer 5

middle cerebral

Question 6

do you get pain?

Answer 6

no, there are no pain receptors in the brain itself

Question 7

strokes most common at which time of day?

Answer 7

morning

Question 8

absolute contraindications to thrombolysis ?

Answer 8

Major surgery 
Active internal bleed 
Prolonged CPR 
Pregnancy 
Severe liver disease 
Hypertension 
Cerebral neoplasm

Question 9

which drugs can cause stroke?

Answer 9

cocaine and OTC cold remedies that contain vasoconstrictors

Question 10

how would you visualise Carotid artery Stenosis?

Answer 10

angiogram of head/neck

Question 11

80% of TIAs due to?

Answer 11

thromboembolus

Question 12

what is Amaurosis fugax?

Answer 12

sudden loss of vision in one eye, caused by an infarct in the retinal artery(ies). You can sometimes see the obstruction on ophthalmoscopy, which is useful clinically, as the same symptoms is seen in migraine – where the arteries will always appear normal. Thus if a defect is visible, it is highly likely to be the result of a TIA

Question 13

After TIA, can check brachial artery pressures, A difference of more than 20mmHg between arms suggests

Answer 13

subclavian artery stenosis

Question 14

which score predicts the likelihood of a further CVA event

Answer 14

ABCD2 score

Question 15

follow up investigations after stroke

Answer 15

carotid doppler scan
echo - to check for cardiac emboli source
ECG
brain imaging?

Question 16

what is the management of a TIA and when would you commence treatment ?

Answer 16

high dose aspirin
once diagnosis is confirmed – usually after CT has confirmed there is no haemorrhage stroke (if symptoms have resolved then almost certainly has been ischaemic rather than haemorrhagic)

Question 17

if symptoms resolve within 24 hours, what does this suggest about the nature of event?

Answer 17

its ischaemic, not haemorrhagic

Question 18

what would clinical picture be from stroke arising from middle cerebral artery?

Answer 18

Hemiparesis
Hemiplegia
Limbs usually floppy, and reflexes reduced/absent
Facial weakness (not always)
Hemianopia – visual field defect in which vision is lost in half of the visual field in one/both eyes.
Aphasia – when the dominant hemisphere is affected
Important to ask about left and right handedness!
These symptoms usually develop rapidly, over a period of minutes, or less commonly they can develop over a few hours.

Question 19

lacunar infarct, where is emboli?

Answer 19

deep arteries of brain

Question 20

infarctions will show up as what shape on both MRI and CT?

Answer 20

wedge shape

Question 21

what is the onset of a stroke like

Answer 21

sudden (a few mins)

Question 22

In stroke, what should be maintained in normal limits?

Answer 22

blood glucose, hydration, oxygen saturation and temperature

Question 23

should be given as soon as possible if a haemorrhagic stroke has been excluded?

Answer 23

aspirin

Question 24

why can children not be given aspirin?

Answer 24

it increases the chance of reyes syndrome

Question 25

with regards to AF, when should anti coagulation be commenced?

Answer 25

until brain imaging has excluded haemorrhage, and usually not until 14 days have passed from the onset of an ischaemic stroke’

Question 26

what time frame should thrombolysis only be given in ?

Answer 26

within 4.5 hours

Question 27

thrombolysis should only be given if wha is excluded?

Answer 27

haemorrhage

Question 28

what drug is given as thrombolysis?

Answer 28

alteplese

Question 29

if patient has seizure at onset of stroke, can they get thrombolysis?

Answer 29

no

Question 30

if patient has had previous TBI or stroke in last 3 months, or suspected? cannot have thrombolysis?

Answer 30

subarachnoid haemorrhage

Question 31

what is recommended as secondary prevention of stroke?

Answer 31

clopidogrel

Question 32

in acute stroke patients, in the absence of haemorrhage, anticoagulation therapy should be commenced after how long in AF?

Answer 32

2 weeks

Question 33

when would patients be on lifelong clopidogrel?

Answer 33

TIA, isachaemic stroke or peripheral arterial disease

Question 34

types of AF?

Answer 34

paroxysmal, permanent, fast

Question 35

continuous atrial fibrillation which cannot be cardioverted or if attempts to do so are deemed inappropriate. which type of AF?

Answer 35

permanent

Question 36

what happens during ischaemic stroke ?

Answer 36

blood supply to an area of the brain is reduced, resulting in tissue hypoperfusion

Question 37

can you get atherosclerosis in the brain vessels?

Answer 37

yes

Question 38

the two subtypes of haemorrhage stroke?

Answer 38

intracerebral haemorrhage

sub arachnoid haemorrhage

Question 39

in SAH, where does the blood collect?

Answer 39

between arachnoid and pia (below the arachnoid)

Question 40

intracerebral can be sub classified into two. what are these?

Answer 40

intraparenchymal (within the brain tissue)

intraventricular (bleeding within the ventricles)

Question 41

4 types of stroke in oxford classification?

Answer 41

TACS
PACS
POCS - posteroir circulation syndrome
LACS

Question 42

what there things need to be present for a diagnosis of TACS?

Answer 42

unilateral weakness
homonomous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 43

which one would you get cerebellar signs in?

Answer 43

POCS

Question 44

pure sensory stroke?

Answer 44

lacunar

Question 45

what is dysphasia?

Answer 45

marked reduction in the generation of speech