Stroke

Question 1

What is a stroke?

Answer 1

Rapidly developing clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin

Question 2

What are the pathophysiological mechanisms of stroke?

Answer 2

• Blocked pipe= ischaemic stroke= 80% so inadequate oxygen and glucose
• Burst pipe= haemorrhagic stroke= 20%

Question 3

What is an ischaemic stroke definition?

Answer 3

An episode of neurological dysfunction caused by focal cerebral, spinal, or retinal infarction.

Question 4

What is silent CNS infarction?

Answer 4

Imaging or neuropathological evidence of CNS infarction, without a history of acute neurological dysfunction attributable to the lesion

Question 5

What is a CNS infarction?

Answer 5

brain, spinal cord, or retinal cell death attributable to ischemia, based on:

pathological, imaging, or other objective evidence of cerebral, spinal cord, or retinal focal ischemic injury in a defined vascular distribution
or
clinical evidence of cerebral, spinal cord, or retinal focal ischemic injury based on symptoms persisting ≥24 hours or until death, and other etiologies excluded.

Question 6

What is an intracerebral haemorrhage?

Answer 6

A focal collection of blood within the brain parenchyma or ventricular system that is not caused by trauma.

Question 7

Describe stroke caused by intracerebral haemorrhage

Answer 7

Rapidly developing clinical signs of neurological dysfunction attributable to a focal collection of blood within the brain parenchyma or ventricular system that is not caused by trauma.

Question 8

What is a silent cerebral haemorrhage?

Answer 8

A focal collection of chronic blood products within the brain parenchyma, subarachnoid space, or ventricular system on neuroimaging or neuropathological examination that is not caused by trauma and without a history of acute neurological dysfunction attributable to the lesion.

Question 9

What is subarachnoid haemorrhage?

Answer 9

Bleeding into the subarachnoid space (the space between the arachnoid membrane and the pia mater of the brain or spinal cord).

Question 10

What is stroke caused by subarachnoid haemorrhage?

Answer 10

Rapidly developing signs of neurological dysfunction and/or headache because of bleeding into the subarachnoid space (the space between the arachnoid membrane and the pia mater of the brain or spinal cord), which is not caused by trauma.

Question 11

What is stroke caused by cerebral venous thrombosis?

Answer 11

Infarction or hemorrhage in the brain, spinal cord, or retina because of thrombosis of a cerebral venous structure. Symptoms or signs caused by reversible edema without infarction or hemorrhage do not qualify as stroke.
=Basilar occlusion is associated with high mortality or severe disability, especially if blood flow is not restored in the vessel; if symptoms such as acute coma, dysarthria, dysphagia, quadriparesis, pupillary and oculomotor abnormalities are detected, urgently seek the input of a stroke specialist

Question 12

Describe the epidemiology of stroke

Answer 12

• Global lifetime risk for age >25 = 25%
• 1:1 sex ratio
• Prevalence increasing

Question 13

Describe the circulation of the brain

Answer 13

• ICA “anterior circulation”

- VA “posterior circulation”

Question 14

Describe Total anterior circulation stroke according to the Bamford classification

Answer 14

-Large cortical stroke
-Anterior or middle cerebral arteries
15% frequency
-Unilateral weakness and/or sensory deficit of the face, arms and legs
-Homonymous hemianopia
-Higher cerebral dysfunction

Question 15

Describe partial anterior circulation stroke (PACS)

Answer 15

-Cortical stroke
-Anterior or middle cerebral arteries
-35%
-Homonymous hemianopia
-Higher cerebral dysfunction
=sudden onset non-fluent (expressive) aphasia
=sudden onset hemiparesis with hemianopia

Question 16

Describe Lacunar stroke

Answer 16

-Subcortical stroke
-Small deep perforating arteries
-25%
-Pure motor, sensory o sensorimotor (min.2 face arms legs)
-Ataxic hemiparesis
=sudden onset hemiparesis

Question 17

Describe posterior circulation stroke

Answer 17

• Cortical, cerebellum, brainstem stroke
• Posterior cerebral artery, vertebral artery, basilar artery and branches
• 25%
• Cerebellar or brainstem syndrome
• Loss of consciousness
• Isolated homonymous hemianopia

Question 18

Nonmodifiable risk factors

Answer 18

Age
Sex
Low birth weight
Race/ ethnicity
Family history
Genetic predisposition

Question 19

Modifiable risk factors

Answer 19

Hypertension
Diabetes
Obesity
Metabolic syndrome
Arterial fibrillation
etc

Question 20

What is hemiparesis?

Answer 20

Hemiparesis, or unilateral paresis, is weakness of one entire side of the body (hemi- means “half”). Hemiplegia is, in its most severe form, complete paralysis of half of the body.

Question 21

What is hemianopia?

Answer 21

Hemianopsia, or hemianopia, is a loss of vision or blindness (anopsia) in half the visual field, usually on one side of the vertical midline.