Stroke

Question 1

what are the types of stroke

Answer 1

haemorrhage:

• structural abnormality
• hypertensive
• amyliod angiopathy

subarachnoid haemorrhage

infarct:

• cardioembolic
• small vessel
• atheroembolic
• other

Question 2

what scan to work out type of stroke

Answer 2

CT (sees if bleed or infarct)

Question 3

what are the features of a posterior circulatory infacrt

Answer 3

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

overall 1 year independence 60%

Question 4

what are the features of a lacunar syndrome

Answer 4

pure motor or sensory deficit affecting two or three of face, arm, leg
or sensorimotor stroke (basal ganglia and internal capsule)

affects down one side but no cortical loss

Question 5

what are the features of total anterior circulation infarct

Answer 5

(contains all three of)
Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss Homonymous Hemianopia
Cortical signs (dysphasia, neglect etc)

Question 6

what type of infarct stroke has the worst prognosis

Answer 6

total anterior circulatory infarction

Question 7

what are the features of a partial anterior circulatory syndrome

Answer 7

2 out of 3 features present in a TACS or;
Isolated Cortical Dysfunction such as dysphasia or;
Pure motor/sensory signs less severe than in lacunar syndromes (eg monoparesis).

Question 8

which has the best prognosis of all the strokes

Answer 8

lacunar syndrome

Question 9

what is lacunar syndrome

Answer 9

Lacunar infarcts are small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in the brain stem.
Caused by occlusion of a single deep penetrating artery. Affect 2 any two of face arm and leg

Question 10

what is lacunar syndrome associated with

Answer 10

hptx
smoking
cholesterol

Question 11

what does a stroke on the right side of the brain affect

Answer 11

creativity 
spatial orientation
artistic awareness 
music 
left side of body

Question 12

what does a stroke on the left side of the brain affect

Answer 12

right side of body 
spoken language 
reasoning 
number skills 
written language

Question 13

which side of the brain is dominant in most people

Answer 13

left

Question 14

what is the most common cause of ischaemic cerebrovascular disease

Answer 14

1. atheroembolism
2. intracranial small vessel disease
3. cardiac source of embolism
4. rare causes- thrombophillia, haemological disorders, genetic disorders

Question 15

what are the most common types of haemorrhage in the brain

Answer 15

1. ischaemic stroke
2. primary intracerebral haemorrhage
3. subarachnoid haemorrhage

Question 16

what is a white plaque and how do you treat it

Answer 16

activated platelets (atherosclosis)
antiplatelets (aspirin, clopidogrel)

Question 17

what is a red clot and how do you treat it

Answer 17

clotting protein, cardioembolic (e.g. AF)

anticoagulants (heparins, doacs)

Question 18

what investigations to look for vascular disease

Answer 18

USS, CT, MR angiography

Question 19

what are the types of small vessel disease

Answer 19

1. ateriosclerotic (age/ risk factor related, most common)
   - fibrinoid necrosis
   - lipohyalinosis
   - microatheroma
   - microaneurysm
2. sporadic and hereditary cerebral amyloid angiopathy
3. genetic (not amyloid)
   - CADASIL
4. inflammatory and immunologically mediated
   - churg strauss, wegeners
5. venous collagenosis
6. other
   - post radiation

Question 20

what can small vessel disease cause in the brain

Answer 20

dementia

Question 21

what is leukoaraiosis

Answer 21

white matter disease (will show patchy white shadows around ventricles on CT)

Question 22

what are the most common causes of cardioembolic strokes

Answer 22

AF
acute MI 
ventricular thrombosis 
rheumatic heart disease 
prosthetic valves

Question 23

is AF a big risk from strokes

Answer 23

yes increases 6xs

i in 6 strokes caused by AF

Question 24

when do venous clots cause stroke

Answer 24

when there is a patent foramen ovale

Question 25

what can prevent further risk of stroke in PFO

Answer 25

clopidogrel | surgery to close hole (only if fit and young)

Question 26

how does arterial dissection cause stroke

Answer 26

``` tear in arterial wall exposes collagen clotting cascade embolises stroke ```

Question 27

what can cause an arterial dissection

Answer 27

hptx | vertebral artery dissection (twisting neck)

Question 28

what is the tx for arterial dissection

Answer 28

antiplatelets / anticoagulation (both effective) | do scan and if vessel healed can stop antithrombotics

Question 29

what are the causes of primary intracranial haemorrhage

Answer 29

``` hptx amyloid angiopathy (deposition creates fragile vessels) ```

Question 30

what are the causes of secondary intracerebral haemorrhage

Answer 30

AVM aneurysm tumour etc

Question 31

what is the main treatment for primary intracerebral haemorrhage

Answer 31

strict BP control

Question 32

where in brain do the different types of primary intracerebral haemorrhage affect

Answer 32

lobar/ peripheral = amyloid angiopathy | deep/ central = BP (internal capsule, basal ganglia)

Question 33

what is the result of early ICH hematoma expansion

Answer 33

Continued arterial bleeding Secondary bleeding into perilesional tissue Subsequent perilesional oedema (mass effects of bleed and oedema damage brain)

Question 34

what do you need to include in the diagnosis of a stroke

Answer 34

type size laterality cause

Question 35

what is the ABCDD of stroke prevention

Answer 35

``` Antithrombotic Therapy -Antiplatelet Therapy -Anticoagulant therapy Blood Pressure Cholesterol Diabetes Don’t Smoke ```

Question 36

what does the CHA2DS2VASc score tell you

Answer 36

risk of getting stroke in patients with AF | 2 or more needs anticoagulation

Question 37

what is the HAS-BLED score

Answer 37

identifies reversible risks of a bleed to make it safer for patients to anticoagulated

Question 38

should you give aspirin or warfarin

Answer 38

aspirin not as affect and just as high risk of a bleed

Question 39

how many falls outweight the benefit of anticoagulation

Answer 39

300 times per year

Question 40

what do you treat cardioembolic stroke with

Answer 40

NOT ASPIRIN use oral anticoagulant

Question 41

what drug can be used to protect against recurrent strokes

Answer 41

perindopril

Question 42

what is low cholesterol associated with

Answer 42

haemorrhagic strokes

Question 43

what surgery can be used to prevent further strokes

Answer 43

``` carotid endarterectomy (need to treat in 2 weeks after stroke) depends on patient and surgical centre expertise ```

Question 44

how is dysphagia managed

Answer 44

swallow screen assessment by s+t therapist if abnormal may need NG tube/ textured diet and thickened fluids assess nutrition and hydration might need medications they dont need to swallow