Stroke

Question 1

Define a stroke

Answer 1

A neurological deficit (loss of function) lasting more than 24 hours and is of vascular origin

Question 2

Define a transiet ischaemic attack

Answer 2

A brief episode neurological deficit lasting less than 24 hours

Question 3

Why does a neurological deficit occur?

Answer 3

Loss of blood supply to part of the brain. This can be due to a clot or bursting of a blood vessel.

Question 4

State the 2 types of stroke and their respective prevalences.

Answer 4

Ischaemic (thrombus or embolus) stroke - 85%

Haemorrhagic stroke - 15%

Question 5

State the aetiology of ischaemic stroke.

Answer 5

• Large artery atheroma
• Small artery occlusion
• Cardiac emboli

Question 6

What is the comments cause of cardioembolic stroke?

Answer 6

Atrial fibrillation

Question 7

What is the comments cause of cardioembolic stroke?

Answer 7

Atrial fibrillation (abnormal heart rhythm)

Question 8

Risk factors for stroke:

Answer 8

• Male (non-modifable)
• Age (non-modifiable)
• Smoking (modifiable)
• Hypertension (modifiable)
• Family history (non-modifiable)
• Race (non-modifiable)
• ATRIAL FIBRILLATION (modifiable)
• Type II diabetes (modifiable)
• Hypercholesterolaemia
• Hyperlipidaemia
• Lack of exercise
• Obesity

Question 9

Symptoms of stroke:

Answer 9

Loss of:

• Coordination
• Vision
• Speech
• Power
• Sensation

Question 10

Signs of a stroke (neurological history/examination):

Answer 10

• Motor (clumsy or weak limb)
• Sensory (loss of feeling)
• Speech: Dysarthria/dysohasia
• Gaze palsy (inability to move eyes in the same direction of motion)
• Vision loss in one eye, or hemianopia
• Ataxia (balance, speech and co-ordination are affected)

Question 11

Investigations for a stroke:

Answer 11

• Clinically diagnosed using the NIHSS (national institute of health stroke scale)
• Neurological examination
• Blood tests: FBC (polycythaemia), U+E, lipids
• 24 hour ECG
• Imaging to include CT, MRI and carotid doppler ultrasound
• Echocardiogram to look for clots in the heart

Question 12

Treatment for a stroke:

Answer 12

• In the stroke unit, focus on mobilising the patient ASAP. The probability of returning home decreases by 20% everyday the patient is not mobilised
• THROMBOLYSIS with ALTEPLASE (restore perfusion before cell death occur, contraindications include age. Safer in <80 year olds)
• Surgical embolectomy
• Hemicraniectomy (for individuals aged up to 60 years who suffer an acute MCA territory ischaemic stroke complicated by massive cerebral oedema)
• Carotid endarterectomy (surgical procedure to remove plaque in the carotid arteries)
• Anticoagulation if AFib

Question 13

How do we identify a stroke?

Answer 13

FAST

• Facial droop
• Arm weekness
• Speech difficultly
• Time to call the emergency services/999