Stroke

Question 1

Define stroke

Answer 1

Sudden death of brain cells due to blockage of blood flow or rupture of an artery to the brain parenchyma

Question 2

List causes of stroke with %

Answer 2

Ischaemia 85%
Haemorrhage 12%
SAH 3%

Question 3

Give 2 reasons why intracranial haemorrhage causes problems

Answer 3

Blood is irritating to brain tissue so it swells

The haematoma that forms raises intracranial pressure

Question 4

List 6 causes of intracranial haemorrhage

Answer 4

HTN 
Ruptured aneurysm or AV malformation 
Haemorrhagic necrosis 
Venous outflow obstruction 
Trauma 
Altered haemostasis

Question 5

Rank the following from lightest to darkest on a CT scan:

CSF, bone, water, Ca, oedema, air, metal, contrast

Answer 5

Metal –> bone –> Ca –> contrast –> blood –> oedema –> water –> CSF –> air

Question 6

What is the word used to describe pattern of haemorrhagic stroke?

Answer 6

Dynamic - slowly expanding haematoma

Question 7

Why is intracranial arterial occlusion a problem?

Answer 7

Results in brain area being deprived of O2 and glucose

Question 8

Where does the anterior circulation come from?

Answer 8

Internal carotids

Question 9

What arteries make up the anterior circulation?

Answer 9

Anterior and middle cerebral arteries

Question 10

What does the anterior circulation supply?

Answer 10

Hemispheres except occipital lobes

Question 11

What arteries make up the posterior supply?

Answer 11

Vertebral and basilar arteries

Question 12

What does the posterior circulation supply?

Answer 12

Brainstem, cerebellum, occipital lobes

Question 13

What happens in the ischaemic cascade?

Answer 13

Cell is stunned so basement membrane stops working
Water seeps into cell uncontrolled
Cells swell and pop
Leads to necrosis
Inflammation occurs due to debris clearing
End up with fluid filled cavity

Question 14

What are the 3 main causes of ischaemic stroke

Answer 14

Large vessel atherosclerosis
Small vessel disease
Cardio-embolic

Question 15

List 3 examples of large vessel atherosclerosis leading to stroke

Answer 15

Intracranial stenosis
Carotid stenosis
Aortic arch plaque

Question 16

What are the risks of large vessel atherosclerosis leading to stroke?

Answer 16

Same as heart disease ones

HTN, DM, age, male, cholesterol, high BMI, FH

Question 17

List 3 examples of cardio embolic causes of stroke

Answer 17

AF
Valve disease
Ventricular thrombi

Question 18

How do you prevent large vessel atherosclerosis from leading to stroke?

Answer 18

Give antiplatelets eg aspirin

Question 19

How do you prevent cardio embolic causes of stroke?

Answer 19

Oral anticoagulation

Question 20

Which are more prevalent in stroke, + or - signs?

Answer 20

Negative

Question 21

How do you investigate a potential stroke?

Answer 21

Hx - inc travel 
ABCDE 
Neuro and systemic exam 
Temp, BP, pulse 
CT /MRI 
FBC 
ECG and dopplers

Question 22

Where is the stroke?

Aphasia, right hemiparesis, sensory loss and visual field defects. Difficulty reading and writing.

Answer 22

Left (dominant) hemisphere

Question 23

Where is the stroke?
Neglect of left visual field, unable to notice left sided stimuli. Left hemiparesis, sensory loss and visual field defects. Spatial disorientation.

Answer 23

Right (non dominant) hemisphere

Question 24

Where is the stroke?

Motor or sensory loss in all 4 limbs. Gait ataxia. Diplopia. Nystagmus. Bilateral visual field loss.

Answer 24

Brain stem / cerebellum / posterior hemispheres

Question 25

Where is the stroke?

Only motor / sensory loss. Ataxic hemiparesis. Dysarthria. Thinking in tact.

Answer 25

Lacunar syndrome (small subcortical hemisphere or brain stem)

Question 26

What is ischaemic penumbra?

Answer 26

Area around centra core of infarction that can be saved if reperfused quickly.

Question 27

What is the clinical implication of the ischaemic penumbra?

Answer 27

Treat ASAP - give thrombolysis within 4.5 hours.