Stroke

Question 1

Give a brief definition of a stroke:

What are the two types?

Answer 1

Stroke - acute compromise of blood supply to the brain

• Cerebral infarction: lack of blood supply due to obstruction 90% of strokes
• Cerebral haemorrhage: intracerebral or subarachnoid, 10% of strokes

Question 2

What is a subarachnoid haemorrhage?

Which age group are most common?

List some clinical features:

Answer 2

Blood in subarachnoid space

• rupture of berry aneurysm of a cerebral artery
• rupture of arteriovenous malformation

Occur in young to middle aged pts - 35-65 years

Clinical features:

• sudden, severe headache - thunderclap
• neck stiffness, photophobia
• vomiting
• impaired level of consciousness

Question 3

How are subarachnoid haemorrhages diagnosed?

Managed?

Outcome?

Answer 3

Diagnosis:

• CT scan, with or w/out angiography to identify aneurysms/lumbar puncture

Management:

• prevent re-bleeding
• coils or surgical clipping

Outcome - may be fatal, spectrum of disability

Question 4

What is an intracerebral haemorrhage?

What is it associated with?

Clinical features?

Answer 4

• directly into brain tissue
• associated with hypertension
• sudden onset headache, nausea and vomiting
• often focal neurological deficit depending on where bleed is

Question 5

List the types of cerebral infarctions:

Answer 5

Transient ischaemic attack (TIA)

• if symptoms resolve within 24hrs
• need urgent medical assessment to reduce chance of progression to permanent stroke

Completed stroke

• neurological deficit >24hrs

Question 6

List some features of a stroke:

Answer 6

• unilateral weakness face/arms/legs (hemiparesis)
• unilateral sensory loss (hemianaesthesia)
• speech problems if dominant hemisphere (dysphasia)
• visual problems (hemianopia)
• higher cortical function loss (neglect, dyspraxia)
• brainstem functions - cranial nerve nuclei, cerebellum

Question 7

What campaign is used for detected stroke?

Answer 7

FAST - face, arm, speech, time

Time is Brain!!

Question 8

What is the emergency treatment of a stroke?

Answer 8

• urgent hospital referral
• consider thrombolysis if present within 4.5 hrs of onset and confirmed ischaemic stroke
• thrombectomy also an option in certain circumstances

Question 9

What is the long term treatment of a stroke?

Answer 9

Infarction:

• antiplatelets: aspirin, dipyridamole, clopidogrel
• anticoagulants if suffer atrial fibrillation
• manage other risk factors e.g. BP, cholesterol, smoking, diabetes

Rehabilitation

Question 10

How are strokes investigated?

Answer 10

Stroke investigation:

CT scanning

Question 11

What can be used in short/long term for nutrition and hydration after a stroke?

Answer 11

• nasogastric tube - short term
• percutaneous endoscopy gastrostomy (PEG) tube - long term

Question 12

What specialists can assist in rehabilitation?

Answer 12

• physiotherapy
• occupational therapy
• doctors/nurses
• speech therapists
• dieticians
• social workers