Stroke (zero to finals)

Question 1

What is another name for a stroke?

Answer 1

Cerebrovascular accident

Question 2

What are the 2 types of cerebrovascular accident?

Answer 2

Ischaemia or infarction of the brain tissue secondary to a disrupted blood supply (ischaemic stroke) = around 85% of cases

Intracranial haemorrhage, with bleeding in or around the brain (haemorrhagic stroke) = around 15% of cases

Question 3

What is ischaemia and infarction?

Answer 3

Ischaemia refers to an inadequate blood supply.

Infarction refers to tissue death due to ischaemia.

Question 4

What can blood supply to the brain be affected by?

Answer 4

A thrombus or embolus

Atherosclerosis

Shock

Vasculitis

Question 5

What is a transient ischaemic attack?

Answer 5

Involves temporary neurological dysfunction (lasting less than 24 hours) caused by ischaemia but without infarction.

Question 6

What is a typical symptom of TIA?

Answer 6

Symptoms have a rapid onset and often resolve before the patient is seen.

Question 7

TIA’s may precede a stroke. True/false?

Answer 7

True

Question 8

What are crescendo TIA’s?

Answer 8

Two or more TIAs within a week and indicate a high risk of stroke.

Question 9

Typical onset and pattern for stroke symptoms?

Answer 9

A sudden onset of neurological symptoms suggests a vascular cause (e.g., stroke).

Stroke symptoms are typically asymmetrical.

Question 10

Typical presentation of stroke?

Answer 10

Limb weakness

Facial weakness

Dysphasia (speech disturbance)

Visual field defects

Sensory loss

Ataxia and vertigo (posterior circulation infarction)

Question 11

Risk factors for stroke?

Answer 11

Previous stroke or TIA
Atrial fibrillation
Carotid artery stenosis
Hypertension
Diabetes
Raised cholesterol
Family history
Smoking
Obesity
Vasculitis
Thrombophilia (abnormal tendency to develop blood clots)
Combined contraceptive pill

Question 12

COCP carries an increased risk of stroke. True/false?

Answer 12

True

The combined contraceptive pill carries a tiny increased risk of stroke.

The risk is higher in patients with migraines with aura, smokers over 34 years or those with a history of stroke or TIA.

Question 13

With COCP there is an increased risk of stroke. What specific factors can further heighten the risk of stroke with COCP?

Answer 13

Migraine with aura

Smokers over 34 years of age

Those with a history of stroke or TIA

Those with a history of VTE (venous thromboembolism)

Question 14

What tool can help to identify stroke within the community?

Answer 14

FAST tool

Face
Arm
Speech
Time (act fast and call 999)

Question 15

What is the initial management of TIA?

Answer 15

Symptoms should have completely resolved within 24 hours of onset. Initial management involves:

• Aspirin 300mg daily (started immediately)
• Referral for specialist assessment within 24 hours (within 7 days if more than 7 days since the episode)
• Diffusion-weighted MRI scan is the imaging investigation of choice.

Question 16

What is the initial management of stroke?

Answer 16

• Exclude hypoglycaemia
• Immediate CT brain to exclude haemorrhage
• Aspirin 300mg daily for two weeks (started after haemorrhage is excluded with a CT)
• Admission to a specialist stroke centre

Question 17

When is thrombectomy used?

Answer 17

Considered in patients with a confirmed blockage of the proximal anterior circulation or proximal posterior circulation.

It may be considered within 24 hours of the symptom onset and alongside IV thrombolysis.

Question 18

In ischaemic stroke, lowering blood pressure is considered always. True/false?

Answer 18

False

Lowering the blood pressure can worsen the ischaemia.

High blood pressure treatment is only indicated in hypertensive emergency or to reduce the risks when giving intravenous thrombolysis.

Blood pressure is aggressively treated in patients with a haemorrhagic stroke.

Question 19

Blood pressure is aggressively treated in patients with a haemorrhagic stroke. True/false?

Answer 19

True

Treated aggressively in haemorrhagic stroke.

Only treated with in ischaemic stroke when there is a hypertensive emergency or to reduce the risks when giving IV thrombolysis.

Question 20

What underlying issues are patients with TIA or stroke checked for?

Answer 20

Investigated for carotid artery stenosis and atrial fibrillation

Question 21

Top risk factors for TIA and stroke and how are these investigated for?

Answer 21

Carotid artery stenosis and atrial fibrillation

All patients with a TIA or stroke will have carotid imaging and ECGs to identify these.

Question 22

Secondary prevention of stroke and TIA?

Answer 22

Clopidogrel 75mg once daily (alternatively aspirin plus dipyridamole)

Atorvastatin 20-80mg (not started immediately – usually delayed at least 48 hours)

Blood pressure and diabetes control

Addressing modifiable risk factors (e.g., smoking, obesity and exercise)