Stroke

Question 1

how can type of stroke be determined?

Answer 1

only by imaging

Question 2

how can size of stroke be determined?

Answer 2

oxford stroke classification scale

divides stroke into 4 syndromes

Question 3

total anterior circulation syndrome features?

Answer 3

big stroke affecting most of anterior circulation
all 3 of
- hemiplegia in 2 of face, arm and leg +/- hemisensory loss
- homonymous hemianopia
- cortical signs (dysphasia, neglect etc)
most severe stroke
60% dead at 1 year

Question 4

PACS features?

Answer 4

2 of 3 of:

• isolated cortical dysfunction such as dysphasia
• pure motor/sensory signs less severe than lacunar syndromes (e.g monoparesis)

Question 5

lacunar syndrome features?

Answer 5

small stroke
hemiplegia but no cortical loss
small infarcts in deeper parts of the brain (ganglia, thalamus etc)
caused by occlusion of single deep penetrating artery
affects 2 of face, arm and leg
best prognosis
assoc with cardio risk factors

Question 6

POCS features?

Answer 6

areas supplied by posterior circulation
cranial nerve palsies
bilateral motor and/or sensory deficits
conjugate eye movement disorders
isolated homonymous hemianopia
cortical blindness
cerebellar deficits without ipsilateral motor/sensory signs (in contrast to ataxic hemiparetic lacunar syndrome)
can cause locked in syndrome

Question 7

function of right side of brain?

Answer 7

left side of body
creativity
music
spatial orientation
artistic awareness

Question 8

function of left side of brain?

Answer 8

right side of body
spoken language
written language
reasoning
number skills

Question 9

dominant hemisphere (left) cortical events often affect what?

Answer 9

language

Question 10

non-dominant hemisphere (right) cortical events often affect what?

Answer 10

spatial awareness

can cause neglect syndrome

Question 11

main causes of ischaemic cerebrovascular disease?

Answer 11

atheroembolism - usually carotid (50%)
intracranial small vessel disease (25%)
cardiac source of embolism (20%)
other (5%)

Question 12

atheroembolism vs cardiac embolism treatment??

Answer 12

antiplatelets (stops platelet cascade which is causing the problem)
anticoagulation

Question 13

type 1 small vessel disease?

Answer 13

arteriosclerotic (age/risk factor related)

• fibrinoid necrosis
• lipohyalinosis
• microatheroma
• microaneurysm

Question 14

type 2 small vessel disease?

Answer 14

sporadic and hereditary amyloid angiopathy

Question 15

type 3 small vessel disease?

Answer 15

genetic small vessel disease distinct from cerebral amyloid angiopathy
small lacunar infarctions
cognitive impairment at younger age
no real treatment

Question 16

type 4 small vessel disease?

Answer 16

inflammatory and immunologically mediated

e.g - vasculitis

Question 17

type 5 small vessel disease?

Answer 17

venous collgenosis

Question 18

type 6 small vessel disease?

Answer 18

other small vessel disease

e.g - post radiation angiopathy

Question 19

what usually causes cardioembolic related ischaemic stroke?

Answer 19

AF (increases risk 5X)

other causes also (prosthetic valves, MI, thrombus etc)

Question 20

PFO?

Answer 20

patent foramen ovale
(between atria)
allows venous clots to pass into arterial chambers of heart which are then pumped out causing a stroke

Question 21

arterial dissection?

Answer 21

tear in arterial wall
exposes collagen etc in wall initiating the clotting cascade etc
can occur due to hypertension or artery disease
can occur in sudden turning of head (swimming, driving etc)

Question 22

management of arterial dissection?

Answer 22

antiplatelets
anticoagulation
rescan after 6 months

Question 23

2 groups of haemorrhagic stroke?

Answer 23

primary intracerebral haemorrhage
- hypertension
- amyloid angiopathy
secondary
- AVM
- aneurysm
- tumour
- etc

Question 24

amyloid vs hypertensive bleed?

Answer 24

amyloid = peripheral
hypertensive = centrally

Question 25

describe expansion of early haematoma?

Answer 25

continued arterial bleeding
secondary bleeding into perilesional tissue
subsequent perilesional oedema

Question 26

ABCD of stroke prevention?

Answer 26

antithrombotic therapy
BP control
cholesterol control
diabetes control
don't smoke

Question 27

what score is used for stroke risk in AF?

Answer 27

CHA2DS2VASc score
- CHF
- hypertension
- age >75 (worth 2)
- diabetes
- stroke/TIA/thromboembolism (worth 2)
- vascular disease
- 65-74 yrs old
- female
2+ = antiplatelet/anticoagulation

Question 28

what score for bleeding risk?

Answer 28

HAS-BLED
- hypertension
- abnormal renal/liver function (1 each)
- stroke
- bleeding
- liable INRs
- elderly
- drugs or alcohol
don't give aspirin or warfarin if significant bleeding risk

Question 29

is aspirin used in stroke?

Answer 29

no
increases bleeding risk and doesn’t reduce stroke risk enough to make it worth it
use anticoagulation instead

Question 30

what are the effects of reducing cholesterol?

Answer 30

low cholesterol = increased haemorrhagic stroke risk but reduced overall stroke risk

Question 31

what surgery can be done for severe arterial disease?

Answer 31

carotid endarterectomy

Question 32

number needed to treat for carotid endarterectomy to prevent 1 stroke 2 years post op?

Answer 32

6

Question 33

management of small vessel disease?

Answer 33

manage risk factors

Question 34

how is dysphagia managed?

Answer 34

initial swallow screen by nurse
if abnormal > assessment by speech and language therapist
may need NG tube placement or textured diet and thickened fluids depending on swallow

Question 35

risks of dysphagia after stroke?

Answer 35

aspiration - pneumonia
malnutrition
dehydration
cant take medication