Strokes and Vascular Disorders

Question 1

Percentage of ischaemic to haemmorhagic stroke

Answer 1

85% ischaemic

15% haemorrhage

Question 2

Causes of ischaemic stroke

Answer 2

Thrombosis:
 - Large arteries (mainly extra-cranial)
 - Small arteries (mainly intra-cranial)
Embolism:
 - From the heart (cardiogenic)
 - From proximal arteries (artery to artery embolism)

Question 3

Internal capsule strokes

Answer 3

End arteries take blood to internal capsule, therefore even a small stroke can cause a large amount of paralysis

Question 4

Modifiable risk factors for stroke

Answer 4

Hypertension
Obesity/lipids
AF
Diabetes
Smoking

Question 5

Pathophysiology of acute ischaemic stroke

Answer 5

Initial reduction in cerebral blood flow
Alterations in cellular chemistry caused by the ischaemia
Cellular necrosis (need to avoid this!)

Question 6

Penumbra in stroke

Answer 6

Area of reduced blood flow but no symptoms around the core section of stroke
Over time the core will get bigger and the penumbra will get smaller

Question 7

Acute treatment of ischaemic stroke

Answer 7

Thrombolysis

Question 8

Stentrievers

Answer 8

Stent that can be withdrawn
Place stent across clot
Reperfuse brain
‘Relax’ and plan strategy
Most clot will lyse naturally or improves efficiency of IV tPA
Withdraw stent with smaller clot ‘core’
Improves outcome for strokes that respond poorly to IV thrombolysis