Strokes

Question 1

Define stroke

Answer 1

Condition characterised by rapidly progressive clinical symptoms and signs of focal loss of cerebral function lasting >24 hours

Question 2

What % of strokes are ischaemic

Answer 2

70-80%

Question 3

What % of strokes are haemorrhagic

Answer 3

20-30%

Question 4

Prevelance of strokes

Answer 4

5/1000

Question 5

What % of people who have a stroke die within the year

Answer 5

1/3

Question 6

What is the leading cause of severe disability

Answer 6

Stroke

Question 7

3 causes of haemorrhagic strokes

Answer 7

Subarachnoid
Intracerebral
Subdural

Question 8

What are the steps of the mechanism of an intracerebral haemorrhage

Answer 8

Charcot-Bouchard microaneurysms
Microbleeds
Haemorrhagic transformation of infarcts
Vasculitis

Question 9

Primary cause of intracerebral haemorrhage

Answer 9

Hypertension

Question 10

What are the complications that could occur from an intracerebral haemorrhage (40

Answer 10

Local damage
Local mass effect
Raised ICP
Hydrocephalus

Question 11

5 steps of managing a ICH

Answer 11

Establish cause
Stop aspirin/ warfarin
Treat complications
Treat risk factors
Rehabilitation

Question 12

Symptoms of a subarachnoid haemorrhage

Answer 12

Sudden severe headache
Nausea and vomiting
Aneurysms

Question 13

What usually causes subarachnoid haemorrhage (3)

Answer 13

Trauma
Ruptured intracranial aneurysm
Arteriovenous malformation

Question 14

Symptoms of subdural hematoma

Answer 14

Numbness, disorientation, slow onset, irritability, headache

Question 15

Name some causes of ischaemic strokes

Answer 15

Atherosclerosis
Carotid stenosis
Carotid dissection
Cardiac
Fat embolism

Question 16

What does ischaemia immediately cause

Answer 16

Failure of Na+/ K+ pumps

Depolarisation

Question 17

What does the depolarisation that results from ischaemia lead to

Answer 17

Glutamate release

Opening of calcium channels

Question 18

What does glutamate release stemming from ischaemia lead to

Answer 18

AMPA receptors
Metabotropic receptors
NMDA receptors

Question 19

Combined effect of glutamate and calcium channel opening?

Answer 19

Elevated intracellular calcium and cell death

Question 20

Name some non-modifiable risk factors for strokes

Answer 20

Age
Previous stroke
Gender
Ethnicity
Family history

Question 21

Name some modifiable risk factors for strokes

Answer 21

Hypertension
Hyperlipidemia
Smoking
CV disease
Diabetes

Question 22

What signs are there if a stroke has affected the anterior circulation

Answer 22

Unilateral motor deficit
Homonymous hemianopia
Higher cerebral function

Question 23

What signs are there if a stroke has affected the posterior circulation

Answer 23

Pure hemianopia
Cerebellar signs
Diplopia
Bilateral/ crossed sensory-motor signs

Question 24

What kind of strokes does TOAST classification focus on

Answer 24

Acute ischaemic strokes

Question 25

5 types of strokes in TOAST classification

Answer 25

``` Large-artery atherosclerosis Cardioembolism Small-vessel occlusion Stroke of other determined aetiology Stroke of undetermined aetiology ```

Question 26

How can large artery atherosclerosis further be categorised

Answer 26

Embolus or thrombosis

Question 27

4 categories of a LACI (lacunar) stroke

Answer 27

Pure motor Pure sensory Ataxic hemiparesis Sensorimotor

Question 28

What % of people are suitable for thombolysis

Answer 28

20

Question 29

What brain structures are supplied by the middle cerebral artery

Answer 29

Motor cortex Sensory cortex Brocas and Wernickes Primary auditory cortex

Question 30

Is the somatosensory cortex in the right or left cerebral hemisphere

Answer 30

Right

Question 31

Is the motor cortex in the right or left cerebral hemisphere

Answer 31

Right