Stroke

Question 1

What is stroke?

Answer 1

Rapidly developing clinical symptoms and/or focal signs, and at times global loss of brain function, with symptoms lasting more than 24h leading to death with no apparent cause other than vascular origin

Question 2

STROKE is a diagnosis TRUE/FALSE

Answer 2

FALSE

It is not a diagnosis, it is the experience of persisting neurological complications of cardiovascular disease

Question 3

Which score helps to diagnose strokes?

Answer 3

Rosier Score

Question 4

What fraction of all stroke presentations are stroke mimics e.g. seizures?

Answer 4

1/3

Question 5

A TIA as compared to a stroke is benign TRUE/FALSE

Answer 5

FALSE

It is not benign

Question 6

What time frame do symtoms have to last for for it to be classed as a TIA rather than a stroke?

Answer 6

Less than 24h

Question 7

Define TIA

Answer 7

A brief episode of neurological dysfunction caused by ischaemia with clinical symptoms typically lasting less then 1h and without evidence of acute infarction

Question 8

Which age group is stroke most common in?

Answer 8

More common in elderly, peak incidence >70 but can occur in other age groups

Question 9

Strokes are more common in females T/F

Answer 9

False

Stroke more common in males

Question 10

What 4 things is the extent of damage determined by?

Answer 10

Arterial territory of the affected artery
Timescale of the occlusion
Extent of the circulatory relief
System perfusion pressure

Question 11

Before how many hours is there very little to observe on microscopy/microscopy after a stroke?

Answer 11

Less than 12h

Question 12

How many days post stroke does the brain become gelatinous and febrile?

Answer 12

2-14 days

Question 13

How long post stroke does it take for microglia to become the predominant cell type?

Answer 13

2-14 days

Question 14

How early does reactive gliosis begin?

Answer 14

As early as wk 1

Question 15

A CT is excellent and always picks up bleeds in the brain TRUE/FALSE

Answer 15

It is rather excellent however if hyperacute it may be essentially normal and it is not sensitive to bleeds over 1 week old

Question 16

MRI is good with stroke at identifying…

Answer 16

Old lesions

Those of non-vascular origin

Question 17

What is the time limit on using IV tissue plasminogen activator?

Answer 17

<4.5h

Question 18

Do not treat cardioembolic stroke with aspirin TRUE/FALSE

Answer 18

TRUE

Question 19

Aspirin can be used after thrombolysis TRUE/FALSE

Answer 19

TRUE but wait 24h

Question 20

ABCDE of prevention of stroke

Answer 20

A-Antithrombotic therapy
B-BP
C-Cholesterole
D-Diabetes
E-Especially don't smoke

Question 21

What fraction of strokes are due to AF?

Answer 21

1/6

Question 22

For the majority of strokes antithrombotic therapy is started?

Answer 22

Aspirin 300mg for 2wks

Question 23

What are the three types of ischaemic stroke?

Answer 23

Cardioembolic
Atheroembolic
Small vessel disease

Question 24

Describe Cardioembolic stroke

Answer 24

Fibrin dependent “red thrombus” e.g. endocarditis

Question 25

Describe atheroembolic stroke

Answer 25

Platelet dependent "white thrombus" e.g. from carotids

Question 26

Where is the most likely place to get a thrombus?

Answer 26

Middle cerebral artery ( as it is aligned with the internal carotid artery)

Question 27

CNS bleeds are the cause of what percentage of strokes?

Answer 27

10%

Question 28

What are the two main reasons for haemorrhage stroke?

Answer 28

BBB disrupted | Damaged vessels

Question 29

What are the four types of stroke?

Answer 29

TACS PACS LACS POCS

Question 30

What is the most severe type of stroke?

Answer 30

Total Anterior Circulation Syndrome (TACS)- only 5% of patients alive at 1 year

Question 31

What are the 3 characteristics of total anterior circulation syndrome?

Answer 31

Hemiplegia involving 2/3 of face, arm,leg Homonymous hemianopia Cortical signs

Question 32

With PACS how many of the patients are alive and independent at 1 year?

Answer 32

50%

Question 33

With PACS they must have 2 of...

Answer 33

Hemiplegia involving 2/3 of face, arm,leg Homonymous hemianopia Cortical signs

Question 34

What are lacunar infarcts?

Answer 34

Small infarcts in the deeper parts of the brain

Question 35

What has the best prognosis of stroke?

Answer 35

LACS

Question 36

What is LACS caused by?

Answer 36

Occlusion of a single deep penetrating artery

Question 37

POCS can lead to multiple presentations, which are some of the most common

Answer 37

``` CN palsies Bilateral motor and/or sensory defecits Conjugate eye movement disorders Isolated homonymous hemianopia Cortical blindness Cerebellar deficits w/o ```

Question 38

What is the right side of the brain responsible for?

Answer 38

Creativity, music, spatial orientation and artistic awareness

Question 39

What is the left side of the brain responsible for?

Answer 39

Spoken language, reasoning, number skills and written language

Question 40

With the small disease classification what type is churg-strauss?

Answer 40

Type 4

Question 41

What is type 1 small vessel disease classification?

Answer 41

Arteriosclerosis

Question 42

Causes of intracerebral haemorrhage

Answer 42

``` Hypertension Amyloid angiopathy AVM aneurysm Tumour ```

Question 43

What are the two scoring tools to determine the risk of bleeding?

Answer 43

CHA2DS2VASc and HAS-BLED

Question 44

Where would the weakness present if the lesion was in the middle v anterior cerebral artery

Answer 44

If middle- contralateral face and arm | If anterior- contralateral leg

Question 45

TRUE/FALSE | Bleeding risk with aspirin is just as big as with warfarin

Answer 45

true

Question 46

What does a cardio protective diet look like?

Answer 46

5+ portions of fruit/veg per day from a variety of sources Two portions of oily fish per wk Replace saturated fasts with polyunsaturated/monounsaturated fats Reduce salt intake Limit alcohol to 14u/week If overweight/obese then lose weight