Vascular Diseases

Question 1

define stroke

Answer 1

a sudden onset focal neurological deficit of vascular aetiology with symptoms lasing >24hrs

Question 2

what is the most common type of stroke?

Answer 2

85% of strokes are ischaemic - occur when blood supply in cerebral vascular territory reduced secondary to stenosis or complete occlusion

Question 3

causes of ischaemic stroke

Answer 3

embolism
thrombosis
systemic hypoperfusion
cerebral venous sinus thrombosis

Question 4

other types of stroke

Answer 4

15% of strokes are haemorrhagic and arise secondary to blood vessel rupture or due to abnormal vascular structures within the brain

Question 5

name the subtypes of haemorrhagic stroke

Answer 5

intracranial haemorrhage

subarachnoid haemorrhage

Question 6

how is stroke classified?

Answer 6

according to the Bamford classification

Question 7

define total anterior circulation stroke (TACS)

Answer 7

unilateral weakness and/or sensory deficit 
homonymous hemianopia 
higher cerebral dysfunction 
headache 
altered conscious

Question 8

define partial anterior circulation stroke (PACS)

Answer 8

only part of anterior circulation compromised and present with two of following:

• unilateral weakness and/or sensory deficit
• homoymous hemianopia
• higher cerebral dysfunction

Question 9

define posterior circulation stroke (POCS)

Answer 9

involves damage to brain areas supplied by posterior circulation that presents with:

cranial nerve palsy
bilateral motor/sensory deficit 
conjugate eye movement 
cerebellar dysfunction 
isolated homonymous hemianopia

Question 10

define lacunar stroke (LACS)

Answer 10

subcortical stroke occurring secondary to small vessel disease that presents with:

purely sensory symptoms
purely motor symptoms
senori-motor symptoms
axtaxic hemiparesis

Question 11

symptoms of haemorrhagic stroke

Answer 11

headache of gradual intensity 
neck stiffness
visual changes
photophobia 
aphasia 
sudden onset 
altered conscious level

Question 12

investigations in stroke

Answer 12

non-contrast head CT
CT angiogram
MRI (with diffuse weighted imaging)

Question 13

common blood tests and results seen in stroke

Answer 13

FBC - exclude anaemia and thrombocytopaenia
U+E - exclude electrolyte disturbance and renal failure
PT, PTT and INR - coagulopathy
serum glucose - exclude hyperglycaemia

Question 14

acute management of ischaemic stroke

Answer 14

ABCDE approach
provide aspirin
admit to stroke ward/centre

if within 4.5hr presenting:
provide r-tPA (alteplase, 0.9mg/kg)

Question 15

contraindications of alteplase or thrombectomy in ischaemic stroke

Answer 15

risk of haemorrhage
recent head trauma
high BP (hypertension)
abnormal glucose levels

Question 16

additional management of ischaemic stroke

Answer 16

if present within 6hrs and have TACS/PACS or within 12hrs POCS, perform mechanical thrombectomy

Question 17

requirements for patient to undergo mechanical thrombectomy

Answer 17

good baseline functional status

lack of early infarction on initial CT scan

Question 18

acute management of haemorrhagic stroke

Answer 18

neurosurgical review

ITU admission if haemorrhage large

Question 19

define idiopathic intracranial hypertension

Answer 19

a syndrome of unknown aetiology that results in raised ICP (opening pressure >25cm H2O)

Question 20

what group is idiopathic intracranial hypertension more common in?

Answer 20

young and obese women

Question 21

clinical features of idiopathic intracranial hypertenion

Answer 21

non-pulsatile, bilateral headaches (worse in the morning, after lying down or bending forward)
vomiting
transient visual darkening/loss
bilateral papilloedema

Question 22

what drugs are associated with idiopathic intracranial hypertension?

Answer 22

oral contraceptive 
steroids
tetracycline 
vitamin A
lithium

Question 23

first line management of idiopathic intracranial hypertension

Answer 23

weight loss

Question 24

additional management of idiopathic intracranial hypertension

Answer 24

carbonic anhydrase inhibitors (e.g. acetazolamide)
topiramate
furosemide
therapeutic lumbar puncture