Stroke

Question 1

d: stroke

Answer 1

Acute onset of
Focal neurological symptoms and signs
Due to disruption of blood supply

Question 2

Name the 2 types of stroke?

Answer 2

Haemorrhagic

Ischaemic

Question 3

What type of stroke is more common?

Answer 3

Ischaemic

Question 4

What is the main cause of Haemorrhagic stroke?

Answer 4

hypertension

Question 5

How may a blood vessel become weakened?

Answer 5

structural abnormalities like aneurysm, 
arteriovenous malformation(AVM)
inflammation of vessel wall(vasculitis)

Question 6

d:hypoperfusion

Answer 6

due to reduced flow of Blood due to stenosed artery rather than occlusion of the artery

Question 7

Are clots in arteries formed via Virchow’s triad?

Answer 7

no atherosclerosis

veins are the triad

Question 8

Risk factors for stroke

Answer 8

Age
Family history of stroke
Gender
Race
Previous stroke

Question 9

Modifiable risk factors of strokes

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

The reduction of Systolic BP via 10mm reduces the risk of CV events by over _____%

Answer 10

20

Question 11

What type of therapy is recommended in hyperlipidaemic patients who have had an ischaemic stroke?

Answer 11

statin

Question 12

Why do some people recover well after stroke and they’ve had brain damage?

Answer 12

they are young and the brain that’s left will take on the function of what’s died

Question 13

Name 6 questions to ask when investigating and stroke?

Answer 13

Is this a stroke?
What kind of stroke is this?
What caused this stroke/TIA?
Have I tried my best to answer question 3?
Is the patient on the appropriate secondary prevention following investigations?
Have I answered any questions the patient has?

Question 14

Name some things that mimic a stroke

Answer 14

Hypoglycaemia
Seizure- postictal states
Migraine
Other metabolic –hyperglycaemia, hyponatremia
Space occupying lesions like brain tumours
Functional hemiparesis

Question 15

what is the only way to differentiate between ischaemic and haemorrhagic stroke?

Answer 15

brain imagaing

Question 16

Name some brain scans

Answer 16

CT
MRI with DWI
MRI with SWI

Question 17

Name the investigations for ischaemic stroke

Answer 17

Blood tests- glucose, lipids, thrombophillia screen in young patients
Assess for hypertension
Any other suggestion that the patient has blood vessel disease like coronary artery disease or peripheral vascular disease- suggests that the stroke may be due to blood vessel disease rather than embolus from heart

Question 18

What is an atherosembolism?

Answer 18

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

  infarcts in same side as 
  affected carotid artery

Question 19

What is a cardioembolism?

Answer 19

embolism from a clot formed in the heart(usually left atrium)
clotting factor rich clots
infarcts in more than one arterial territory, bilateral

Question 20

What sort of scanning would an atheroembolism require?

Answer 20

carotid scanning, CT/MR angiogrphy of aortic arch

Question 21

What sort of testing would you do for cardioembolism?

Answer 21

ECG- ?AF, ?old ischaemic changes(mural thrombus)
?LVH (suggests uncontrolled hypertension-commonest cause of AF)
Echocardiogram (transthoracic, transoesophageal, bubble contrast study to look for interatrial connection)
24 hour- 5 day ECG monitor tests (Paroxysmal AF)

Question 22

If the patient is hypertensive? where is he clot?

Answer 22

usually deep in the brain

Question 23

If the patient is young and not hypertensive what do you need to examine for?

Answer 23

investigate underlying aneurysm AVM
multiple haemorrhages
vasculitis, Moya Moya disease, cerebral amyloid angiopathy

Question 24

What can be done to reverse disability? and timings?

Answer 24

Thrombolysis- upto 4.5 hrs from onset of symptoms

Thrombectomy- upto 6 hrs from symptom onset, usually after having started thrombolysis

Question 25

treatment if atheroembolic or due to thrombus?

Answer 25

``` Antiplatelets(Aspirin 75 mg + Dipyridamole MR 200 mg twice daily/Clopidogrel 75 mg daily) Statins to treat high lipids Diabetes management Hypertension management Lifestyle advice ```

Question 26

if its due to atrial fibrillation, what is the treatment?

Answer 26

Warfarin (Vitamin K antagonist) Direct acting oral anticoagulants (act by inhibiting clotting factors directly like factor X and thrombin) Rivaroxaban, Dabigatran, Apixaban, Edoxaban

Question 27

Name some surgical treatments for stroke?

Answer 27

``` Haematoma evacuation Relief of raised intracranial pressure Obstructive hydrocephalus Large total MCA infarctions Carotid endarterectomy >70% stenosis in same sided internal carotid artery(as affected side of brain) ```

Question 28

d: Transient Ischaemic Attacks

Answer 28

Temporary neurological symptoms due to occlusion of artery stopping flow of blood - temporary b’cos arteries are capable of dissolving small clots

Question 29

Why are TIAs treated as emergencies?

Answer 29

as stroke risk after is very high

Question 30

in what type of stroke do you not give anticoagulants?

Answer 30

haemorrhagic

Question 31

What is better for stroke imaging CT/MRI?

Answer 31

CT