Stroke and Vascular Disease

Question 1

what are the 5 characteristics of a clinical diagnosis of a stroke?

Answer 1

sudden onset
focal neurological deficit
of presumed vascular origin
symptoms lasting more than 24hrs

Question 2

If stroke symptoms last less than 24hrs, what is the clinical diagnosis?

Answer 2

Transient Ischaemic Attack (TIA)

Question 3

What are the 2 pathalogical diagnoses of stroke?

Answer 3

cerebral infarction or cerebral haemorrhage

Question 4

What is the pathophysiology of acute ischaemic stroke?

Answer 4

• initial reduction in cerebral blood flow
• alternations in cellular chemistry caused by the ischaemia
• cellular necrosis

Question 5

Can the brain store energy?

Answer 5

NO - if you interrupt the delivery of energy, function stops

Question 6

What is the sole subrtate for cerebral energy metabolism?

Answer 6

glucose

Question 7

What is the threshold of rate of blood flow for the brain to retain normal function?

Answer 7

20 ml/100g/min

Question 8

Restore in blood flow means that which areas of the brain are salvageable?

Answer 8

Oligemia and penumbra

Question 9

Define a TIA

Answer 9

Neurological Deficit lasting less than 24 hours attributable to
cerebral or retinal ischaemia

Question 10

Name 3 vascular risk factors

Answer 10

carotid artery disease
cerebral small vessel disease
cardiac embolism

Question 11

What percentage of strokes are preceded by a TIA?

Answer 11

20%

Question 12

What is the incidence of TIAs?

Answer 12

50/100 000 population

Question 13

Name 5 TIA (stroke) mimics

Answer 13

• seizures
• syncope
• hypoglycaemia
• migraine
• acute confusional states

Question 14

What symptoms would you see if the anterior circulation (supplied by carotid arteries) is effected?

Answer 14

• amarausis fugax
• dysphagia
• apraxia
• inattention

Question 15

What symptoms would you see if the posterior circulation (supplied by vertebral arteries) is effected?

Answer 15

• ataxia
• diplopia
• vertigo
• bilateral symptoms

Question 16

How would you assess a patient with suspected TIA?

Answer 16

• visual field disturbance
• hemiparesis
• hemisensory loss
• dysarthia

Question 17

What factors are measured when calculating stroke risk?

Answer 17

Age, BP, Clinical features, Duration symptoms, Diabetes

Question 18

What are combined in POLYPILL?

Answer 18

statin, aspirin, antihypertensives, folic acid

Question 19

Is a carotid endarterectomy primary or secondary vascular prevention?

Answer 19

secondary

Question 20

What visual defect would you expect in someone immediately post stroke?

Answer 20

homonymous hemianopia

Question 21

Where would you expect weakness in someone who has suffered a stroke?

Answer 21

collateral weakness of limbs

weakness and incoordination of oropharyngeal muscles

Question 22

What happens in someone with damage to Broca’s area?

Answer 22

‘expressive dysphasia’

difficulty finding words and flow of speech is stilted

Question 23

What happens in someone with damage to Wernicke’s area?

Answer 23

‘receptive dysphasia’

fluent flow of speech but with impaired comprehension and neologisms

Question 24

How do you assess swallowing?

Answer 24

• position patient correctly and ensure alert
• give a single teaspoon of water
• are the coughing/drooling/wet voice? (YES = unsafe swallowing -> nil by mouth -> end assessment)
• give further 2 teaspoons
• assess again…
• give 50ml
• if this is okay then SAFE TO SWALLOW