Stroke Prevention Part 1

Question 1

TIA definition

Answer 1

Transient ischemic attack
Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia
Without acute infarction

Question 2

2 types of hemorrhagic strokes

Answer 2

Subarachnoid

Intraparenchymal

Question 3

6 mechanisms of ischemic strokes

Answer 3

Lacunar stroke
Intracranial atherosclerosis
Carotid artery stenosis
Cardiembolic sources
Paradoxical emboli
Cryptogenic strokes (unknown cause)

Question 4

Small vessel lacunar stroke

Answer 4

Blockages of the tiny penetrating arteries in the brain

Question 5

Cardioembolism

Answer 5

Clot forms in the heart and then embolizes distally into the brain

Question 6

4 non modifiable stroke risk factors

Answer 6

Age
Low birth weight
Race/ethnicity
Genetics

Question 7

10 most important modifiable stroke risk factors

Answer 7

HTN
Current smoking
Waist to hip ratio
Diet
Physical inactivity
Diabetes
Alcohol
Apolipoprotein ratio/cholesterol
Cardiac disease
Psychosocial stress/depression

Question 8

What SBP does stroke risk start to increase at?

Answer 8

SBP above 115 mmHg

Question 9

What is the most important risk factor for intracerebral hemorrhage?

Answer 9

Hypertension

Question 10

What is the general optimal target for BP?

Answer 10

Less than 140/90

Question 11

How does 
1. Total cholesterol
2. HDL cholesterol
3. Treatment of dyslipidemia 
influence stroke?

Answer 11

1. High levels = increase risk of ischemic. Low levels = increase risk of hemorrhagic
2. High levels = low risk of cardiac disease (no relationship with stroke)
3. Statins = reduces risk of ischemic stroke

Question 12

How does diet influence stroke risk?

Answer 12

High salt, low K, high alcohol indirectly increase stroke risk
High fruit intake decreases stroke risk

Question 13

3 main things on DDx of a TIA

Answer 13

Stroke (minor stroke could have reversed deficits but evidence of infarct)
Focal seizure
Migraine aura

Question 14

ABCD2 Score

Answer 14

For people at high risk of stroke following a TIA
Age (> 60)
BP (> 140/90)
Clinical features (isolated speech = 1 pt, unilateral weakness = 2 pts)
Diabetes
Duration of TIA symptoms (10-59 mins = 1 pts, >60 mins = 2 pts)

Question 15

ABCDE for secondary stroke prevention

Answer 15

A: antithrombotic
B: BP control
C: cholesterol (statin)
D: diabetes and diet
E: exercise and lifestyle

Question 16

2 mechanisms that you never want to miss

Answer 16

Symptomatic carotid artery stenosis

Atrial fibrillation