STROKE TFW

Question 1

What is stroke?

Answer 1

It is a clinical syndrome of presumed vascular origin characterized by rapidly developing signs of focal or global disturbance of cerebral functions which lasts longer than 24 hours or leads to death.

Question 2

List the two sub types of stroke

Answer 2

1.Ischaemic stroke
2. Haemorrhagic stroke
3. Silent stroke

Question 3

Define Ischaemic stroke

Answer 3

an episode of neurological dysfunction caused by focal cerebral, spinal, or retinal cell death due to infarction following vascular occlusion or stenosis.

Question 4

Define Haemorrhagic stroke

Answer 4

apidly developing neurological dysfunction due to a focal collection of blood from within the brain parenchyma or ventricular system (intracerebral haemorrhage), or bleeding into the arachnoid space (subarachnoid haemorrhage) that is not caused by trauma.

Question 5

What is silent stroke?

Answer 5

radiological or pathological evidence of an infarction or haemorrhage not caused by trauma without an attributable history of acute neurological dysfunction attributable to the lesion.

Question 6

What is TIA? Transient Ischaemic Attack

Answer 6

a transient (less than 24 hours) neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without evidence of acute infarction.

A TIA has a sudden onset and can last from a few minutes to 24 hours. Most people have complete resolution of symptoms and signs within 1 hour.

Question 7

What causes stroke and TIA?

Answer 7

1. About 85% of strokes are ischaemic , Ischaemic strokes occur when large arteries are occluded by:
   Thrombus (often as a complication of atherosclerosis), or
   Embolus of fatty material from an atherosclerotic plaque or a clot in a larger artery or the heart (often as a complication of atrial
   fibrillation or atherosclerosis of the carotid arteries).
2. About 15% of strokes are haemorrhagic
3. Due to rarer causes such as cerebral venous thrombosis and Carotid artery dissection

Question 8

state the lifestyle risk factors for stroke

Answer 8

Smoking.
Alcohol misuse and drug abuse (for example cocaine, methamphetamine).
Physical inactivity.
Poor diet.

Question 9

State the Established cardiovascular disease risk factors for stroke

Answer 9

Hypertension.
Permanent and paroxysmal atrial fibrillation (AF) — AF causes at least 20% of ischaemic strokes.
Infective endocarditis.
Valvular disease.
Carotid artery disease — atheroma and stenosis of the carotid arteries are commonly associated with stroke and TIA.
Congestive heart failure.
History of myocardial infarction.
Congenital or structural heart disease including patent foramen ovale.

Question 10

List other medical conditions that poses a risk factor for stroke

Answer 10

Migraine — there is an elevated risk of stroke associated with migraine, particularly in younger women and in those with migraine with aura.
Brain hypoperfusion occurs in people with severe migraine with aura. Combined oral contraceptives should be avoided in women with this condition and prior ischaemic stroke.
Hyperlipidaemia.
Diabetes mellitus.
Sickle cell disease.
Haemophilia.
Antiphospholipid syndrome and other hypercoagulable disorders.
Chronic kidney disease.
Ehlers-Danlos syndrome.
Marfan syndrome.
Pseudoxanthoma elasticum.
Polycystic kidney disease.
Neurofibromatosis type I.
Obstructive sleep apnoea (OSA) — cardiovascular risk factors such as hypertension, diabetes, smoking, and obesity are common in people with OSA but it is also an independent risk factor for stroke.
Vascular malformations.

Question 11

list other risk factors for stroke

Answer 11

Older age — the risk of stroke rises sharply with age.
Male sex — males are more likely to have a stroke at a younger age. In women, an increased risk of stroke has been associated with current use of combined oral contraceptives, the immediate postpartum period, and pre-eclampsia.
Anticoagulation.
Previous TIA/stroke, or family history of stroke.
Lower level of education.
Genetic or hereditary factors.

Question 12

Stroke is a leading cause of death and disability, causing around 38,000 deaths each year in the UK.. True/false

Answer 12

True

Question 13

State the age of stroke onset

Answer 13

Strokes are occurring at an earlier age — age at onset fell from 70.5 to 68.2 years in males and 74.5 to 73.0 years in females between 2007 and 2016, and over a third of strokes occurred in adults aged between 40 and 69 years.

Question 14

State complications in the early period following stroke

Answer 14

Haemorrhagic transformation of ischaemic stroke.
Cerebral oedema.
Delirium.
Seizures.
Venous thromboembolism — pulmonary embolism has been associated with 13–25% of deaths in the early period following stroke.
Cardiac complications — cardiac complications (myocardial ischemia, congestive heart failure, atrial fibrillation, and arrhythmias) are common due to shared aetiology.
Infection — people with stroke are at increased risk of infection including aspiration pneumonia, urinary tract infection, and cellulitis from infected pressure sores.

Question 15

list the long term complications associated with stroke?

Answer 15

1. Mobility problems such as Hemiparesis or hemiplegia, ataxia ,falls, Spasticity and contractures.
2. Sensory problems
   3.Continence problems
   4.Pain
3. Fatigue
   6.Problems with swallowing, hydration, and nutrition
   7.Sexual dysfunction
   8.Skin problems
   9.Visual problems
   10.Cognitive problems
   11.Difficulties with activities of daily living (ADL)
   12.Emotional and psychological problems
   13.Communication problems
   14.Financial problems

Question 16

What are the clinical features of TIA?

Answer 16

The person presents with sudden onset, focal neurological deficit which has completely resolved within 24 hours of onset and cannot be explained by another condition such as hypoglycaemia. Most TIAs are thought to resolve within 1 hour but can persist for up to 24 hours. Focal neurological deficits may include:
Unilateral weakness or sensory loss.
Dysphasia.
Ataxia, vertigo, or loss of balance.
Syncope.
Sudden transient loss of vision in one eye (amaurosis fugax), diplopia, or homonymous hemianopia.
Cranial nerve defects.

Question 17

What are the clinical features of stroke

Answer 17

The person presents with sudden onset, focal neurological deficit which is ongoing or has persisted for longer than 24 hours and cannot be explained by another condition such as hypoglycaemia. The clinical features of stroke vary depending on causative mechanism and the area of the brain affected and may include:
Confusion, altered level of consciousness, and coma.
Headache — usually of insidious onset and gradually increasing intensity in intracranial haemorrhage, and sudden, severe headache in subarachnoid haemorrhage which may be associated with neck stiffness. Sentinel headache(s) may occur in the preceding weeks.
Unilateral weakness or paralysis in the face, arm, or leg.
Sensory loss — paraesthesia or numbness.
Ataxia.
Dysphasia.
Dysarthria.
Visual disturbance — homonymous hemianopia, diplopia.
Gaze paresis — this is often horizontal and unidirectional.
Photophobia.
Dizziness, vertigo, or loss of balance — isolated dizziness is not usually a symptom of TIA.
Nausea and/or vomiting.
Specific cranial nerve deficits such as unilateral tongue weakness or Horner’s syndrome (miosis, ptosis, and facial anhidrosis).
Difficulty with fine motor coordination and gait.
Neck or facial pain (associated with arterial dissection

Question 18

State the symptoms of posterior circulation stroke

Answer 18

Symptoms of acute vestibular syndrome — acute, persistent, continuous vertigo or dizziness with nystagmus, nausea or vomiting, head motion intolerance, and new gait unsteadiness.

Question 19

list other conditions that mimics stroke

Answer 19

Toxic/metabolic disturbance such as:
Hypoglycaemia.
Drug and alcohol toxicity.
Conditions which can cause dizziness or disturbed balance such as:
Syncope.
Labyrinthine disorders — vertigo, Meniere’s disease, labyrinthitis.
Neurological conditions such as:
Seizure.
Migraine with aura.
Demyelination — multiple sclerosis.
Peripheral neuropathies such as Bell’s palsy.
Spinal epidural haematoma.
Trauma
Systemic or local infection including:
Central nervous system abscess.
Encephalitis.
Sepsis.
Encephalopathies such as:
Hypertensive encephalopathy.
Wernicke’s encephalopathy.
Space occupying lesions including:
Tumour.
Subdural haematoma.
Other conditions such as:
Acute confusional state.
Dementia.
Vasculitis.
Somatoform or conversion disorder.

Question 20

State How should I manage a person with suspected acute stroke?

Answer 20

Arrange immediate emergency admission to an acute stroke facility for anyone with suspected acute stroke or emergent transient ischaemic attack (TIA).
Be aware that a person may have ongoing focal neurological deficits despite a negative FAST test — if suspected manage as acute stroke.
Ensure the hospital receives advanced notification of arrival — this should include details of time of onset, symptom evolution, current condition, and medications (especially anticoagulants).
Do not start anticoagulation (for example in people with atrial fibrillation) or antiplatelet treatment in people following ischaemic stroke until intracerebral haemorrhage has been excluded by brain imaging.
While awaiting transfer:
Monitor and manage any deterioration in clinical condition (airway, breathing, and circulation [ABCs]).
Give supplemental oxygen to people with acute stroke if oxygen saturations are less than 95% and there are no contraindications.