Stroke Presentation

Question 1

what is the definition of a stroke

Answer 1

neurological deficit

1. of sudden onset
2. lasting more than 24hrs
3. of vascular origin

Question 2

what are the 5 symptoms of stroke?

Answer 2

loss of

1. power
2. speech
3. vision
4. coordination
5. sensation

Question 3

what are the two types of stroke

Answer 3

1. heamorrhagic (rupture of blood vessel)

2. ischaemic (blockage of a blood vessel)

Question 4

what areas does the carotid blood system supply

Answer 4

most of the hemispheres and cortical deep white matter

Question 5

what areas does the vertebro-basilar blood system supply

Answer 5

cerebellum and occipital lobes

Question 6

what is another name for a stroke that occurs in the deep white matter

Answer 6

lacunar stroke

Question 7

define a Total anterior circulation stroke (TACS)

Answer 7

large cortical stroke in middle/anterior cerebral artery

Question 8

define a Partial anterior circulation stroke (PACS)

Answer 8

cortical stroke in middle/anterior cerebral artery areas

Question 9

if a patient has had a TACS what symptoms may they present with (4)

Answer 9

weakness
sensory deficit
loss of vision
higher cerebral dysfunction

Question 10

if a patient has had a PACS (most common type) what symptoms may they present with

Answer 10

weakness
sensory deficit
restricted movement e.g in one limb
loss of vision

Question 11

what is the most common lacunar stroke

Answer 11

pure motor

Question 12

what investigations would you do for a stroke

Answer 12

full blood count 
CT scan
MRI scan 
Carotid doppler
(sometimes Echo - can be helpful in looking for clots in the heart)

Question 13

what is the difference between a stroke and a TIA

Answer 13

in a TIA symptoms will resolve within 24hrs

Question 14

what type of stroke is the most common

Answer 14

PACS-partial anterior circulation stroke 35%

Question 15

what type of stroke has the highest mortality at 1 year

Answer 15

TACS 60% at 1 year

Question 16

what are 2 modifiable risk factor for stroke

Answer 16

high blood pressure

atrial fibrilation

Question 17

what are 3 non-modifiable risk factors for stroke

Answer 17

age
race
family history

Question 18

what are the investigations for stroke

Answer 18

Blood tests
ECG
CT
MRI

Question 19

an echo can be a useful investigation in stroke, why

Answer 19

useful to look for clots in the heart

Question 20

what are the main differences between CT and MRI

Answer 20

CT:
quick
shows up blood

MRI:
takes up to 30 mins
claustrophobic
shows up ischaemic stroke better

Question 21

discuss secondary prevention of stroke

Answer 21

vascular risk factor are identified:
smoking 
hypertension
hyperlipidemia
diabetes mellitus 

and managed appropriately

Question 22

what are the causes of stroke

Answer 22

blockage of a vessel with thrombus or clot

disease of vessel wall

disturbance of normal blood properties

rupture of vessel wall-haemorrhage

Question 23

what is the commonest cause of a cardioembolic stroke

Answer 23

atrial fibrillation

Question 24

what is a rare cause of stroke

Answer 24

carotid dissection this can happen in trauma or be idiopathic

(remember the dentist with locked in syndrome)

Question 25

what is the general drug treatment for stroke

Answer 25

clopidogrel or Aspirin
statin
blood pressure drugs

Question 26

which patients would qualify for an endarterectomy

Answer 26

with 50-70% stenosis