Stroke Treatments- Khalil

Question 1

Which of the following statements about stroke treatments is/are correct?

a. i.v. thrombolysis is the only treatment that is available when symptom onset has gone for longer than 4.5 h
b. i.v. trhombolysis is good for both hemorrhagic and ischemic stroke
c. mechanical thrombectomy is performed when the blocked vessel is large, up to 24 h from symptom onset (most useful 6-12 h after onset)
d. i.v. thrombolysis was the first effective stroke treatment and was introduced in the 1960s

Answer 1

c. mechanical thrombectomy is performed when the blocked vessel is large, up to 24 h from symptom onset (most useful 6-12 h after onset)

Question 2

What is the only clinically proven pharmacological therapy in ischemic stroke?

Answer 2

i.v. Thrombolysis (with tPA)

Question 3

why is it important to do a CT scan immediately after a stroke patient arrives at the hospital?

Answer 3

• CT cannot be used to see a lesion at this time (or very very hard)
• is used because with CT you can detect hemorrhage
• if hemorrhage is present –> do NOT use i.v. throbolysis

Question 4

what is the percentage of patients who are eligible for stroke treatment an for what reason can’t all patients receive treatment?

Answer 4

• only 10% of patients can get treatment

- reason- too late or impossible to determine onset

Question 5

what is the difference between cytotoxic and vasogenic oedema and what imaging techniques can be used to visualise them?

Answer 5

cytotoxic oedema- cell swelling due to disruption of the ionic gradient in and outside the cell –> excessive Na+ influx drags water in; important for imaging because of the change in Brownian motion.
- method- DWI- cell swelling leads to decreased diffusion

vasogenic oedema- accumulation of water outside the cell–> suppression of CSF
- method- FLAIR

Question 6

Which of the following statements about stroke treatments is/are wrong?

a. cytotoxic oedema occurs earlier than vasogenic oedema, so when imaging the brain at this stage there is a pathology in DWI but not in FLAIR (mismatch)
b. very early in stroke development, blocked vessel can be imaged with angiography
c. cytotoxic oedema occurs early in stroke development and is replaced by vasogenic oedema, so when imaging the brain more than 5 h after onset there is a pathology in DWI but not in FLAIR (mismatch)
d. a and b

Answer 6

c. cytotoxic oedema occurs early in stroke development and is replaced by vasogenic oedema, so when imaging the brain more than 5 h after onset there is a pathology in DWI but not in FLAIR (mismatch)