stroke

Question 1

what is a stroke?

Answer 1

acute onset of focal neurological symptoms and signs due to disruption of blood supply

Question 2

incidence

Answer 2

3rd largest cause of death in scotland, more than 100,000 stroke in the UK each year

Question 3

prevalence

Answer 3

2/3 stroke survivors leave hospital with a disability

Question 4

economic impact

Answer 4

loss of independence, burdens to carers/families, loss of earnings

Question 5

types - haemorrhagic

Answer 5

(10-15%)
bleeding occurs inside or around brain tissue
*can get loads of type of intracranial haemorrhage (ie extradural, subdural/subarachnoid)
INTRACEREBRAL is the stroke - the only one with brain damage

Question 6

risk factors - fixed

Answer 6

age - risk increases passives after the age of 65
family history of stroke
gender
race
previous stroke

Question 7

type - ischaemic

Answer 7

(80-85%)
a clot blocks blood flow to an area of the brain
can get:
thrombotic - clot blocking artery at the site of occlusion
embolic - clot blocking artery has travelled to artery it occludes from somewhere more proximal in the arteries or the heart
hypo perfusion - due to reduced blood flow due to stenosed artery

Question 8

causes of haemorrhagic stroke

Answer 8

> concerned with blood ie haemorrhagic diathesis, anticoagulants, strong antiplatelets
concerned with vessel wall
ie hypertension due to arteriosclerosis, vasculitis, vessel wall abnormalities (aneurysms, AVMs, amyloid antipathies)

Question 9

venous clots vs arterial clots

Answer 9

arterial = arterial wall disease ie plaque due to atherosclerosis > treated by anti-platelets, usually lead to ischaemic arterial disease !! stroke !! peripheral arterial embolism

venous = imbalance between the arms of Virchow’s triad (haemostasis, hypercoagulability, endothelial injury) > treated by anticoagulants, usually causes DVTS and PEs

Question 10

arteriosclerosis

Answer 10

is the thickening and stiffening of arterial walls > can co-exist with atherosclerosis and are more likely to cause ischaemic stroke

Question 11

risk factors - modifiable

Answer 11

hypertension - even a 10mm reduction in SBP reduces risk of CV events 
hyperlipidaemia 
smoking - doubles risk of ischaemic stroke 
prior history of TIA 
AF
diabetes
congestive heart failure
alcohol excess
obesity 
physical inactivity
poor socioeconomic status

Question 12

rarer causes of stroke

Answer 12

(esp. in younger pop.)
homocysteinemia
vasculitis, antiphospholipid antibody syndrome, protein S/C and antithrombin III deficiency