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 is a haemorrhagic stoke?

Answer 2

raised blood pressure
weakened vessel wall due to structural abnormalities like aneurysm, arteriovenous malformation (AVM) and inflammation of the vessel wall (vasculitis)

Question 3

what are the 3 types of ischaemic stroke?

Answer 3

thrombotic
embolic
hypoperfusion

Question 4

describe a thrombotic stroke

Answer 4

clot blocking an artery at the site of the occlusion

Question 5

describe an embolic stroke

Answer 5

clot blocking artery has travelled to artery it occludes from somewhere more proximal in the arteries or the heart

Question 6

describe a stroke due to hypoperfusion

Answer 6

due to reduced flow of blood due to stenosed artery rather than occlusion of artery

Question 7

what are the 3 factors leading to thrombosis?

Answer 7

circulatory stasis
endothelial injury
hypercoagulable state

Question 8

what are the non modifiable risk factors for stroke?

Answer 8

age
family history of stroke
gender
race 
previous stroke

Question 9

what are the modifiable risk factors for stroke?

Answer 9

hypertension
hyperlipidaemia
smoking
prior history of TIA especially if recent and recurrent
atrial fibrillation
diabetes
congestive heart failure
alcohol excess
obesity 
physical inactivity 
poor socioeconomic status

Question 10

what are some rarer causes of stroke?

Answer 10

homocysteinemia
vasculitis
antiphopholipid antibody syndrome
protein S, C, antithrombin III deficiency 
paradoxical embolism through patent foramen ovale/ pulmonary AV shunts 
genetic 
cardioembolic 
cervical artery dissection

Question 11

what is a paradoxical embolism?

Answer 11

venous clot to arterial side

Question 12

what are genetic causes of stroke?

Answer 12

factor V leiden mutation
common prothrombin mutation
MELAS
CADASIL
fabry's disease

Question 13

what are cardioembolic causes of stroke?

Answer 13

mural thrombi
infective endocarditis
myxoma

Question 14

what does a stroke present with?

Answer 14

it mimics conditions that present acutely with focal neurological signs but are no due to interrupted blood flow
eg hypoglycaemia, seizure, migraine, space occupying lesions in the brain, functional hemiparesis

Question 15

what is an atheroembolism?

Answer 15

embolism from a thrombus forming an atherosclerotic plaque- platelet rich clots

Question 16

where does an atheroembolism infarct?

Answer 16

in the same side as he affected carotid artery

Question 17

what is an cardioembolism?

Answer 17

embolism from a clot formed in the heart (usually left atrium)
clotting factor rich clots

Question 18

where does a cardioembolism infarct?

Answer 18

in more than one arterial territory, bilateral

Question 19

what to do if suspected atheroembolism?

Answer 19

carotid scanning

CT/MR angiography of each aortic arch

Question 20

what to do if suspected caridoembolism?

Answer 20

ECG- AF?, old ischaemic changes?, LVH?

Question 21

what to do if suspected haemorrhagic stroke?

Answer 21

investigate cause of bleed
hypertensive- usually deep in the brain, older patients
if young- investigate for underlying aneurysm, AVM
if multiple haemorrhages- vasculitis? moya moya disease?, cerebral amyloid angiopathy?

Question 22

how to reverse the disabilities of an ischaemic stroke?

Answer 22

thrombolysis up to 4.5 hrs from onset of symptoms

thrombectomy- up to 6hrs from onset of symptoms

Question 23

what is t-PA used for?

Answer 23

an IV injection to dissolve blood clots

Question 24

what medical management is used to prevent another stoke if atheroembolic or due to thrombus?

Answer 24

antiplatelets 
statins
diabetes management
hypertension management
lifestyle advice

Question 25

what medical management is used to prevent another stroke if due to AF?

Answer 25

warfarin

direct oral anticoagulants

Question 26

what surgical management can be used?

Answer 26

haematoma evacuation
relief of raised intracranial pressure
carotid endarterectomy

Question 27

what is a transient ischaemic attack?

Answer 27

temporary neurological symptoms due to occlusion of artery stopping flow of blood but arteries are capable of dissolving small clots