Week 202 - Stroke:

Question 1

Week 202 - Stroke: What are the basic set of investigations that should be applied to all individuals?

Answer 1

FBC, BP, ECG, CXR, Cerebral imaging (CT/MRI)

Question 2

Week 202 - Stroke: What are the two basic principles of treatment for stroke?

Answer 2

• To reduce/reverse the impact of the damage (E.g Thrombolysis/rehabilitation)
• Reduce the risk of recurrence.

Question 3

Week 202 - Stroke: What is thrombolysis and on who should it be performed?

Answer 3

• I.V. recombinant tissue plasminogen activator (rTPA)

* Patient selection is VITAL, <3hrs and no risk factors for developing intracerebral haemorrhage.

Question 4

Week 202 - Stroke: Give a basic definition of stroke.

Answer 4

A neurological deficit related to an atraumatic vascular event.

Question 5

Week 202 - Stroke: What are the two broad categories of stroke and what % does each make up of cases?

Answer 5

• Ischaemic - 85%

* Ischaemic - 15%

Question 6

Week 202 - Stroke: What are the major vessels that make up the anterior part of the intracerebral circulation?

Answer 6

• Internal carotids
• Anterior cerebral artery
• Middle cerebral arteries
+ Anterior and posterior communicating arteries.

Question 7

Week 202 - Stroke: What are the major vessels that make up the posterior part of the intracerebral circulation?

Answer 7

• Vertebral arteries
• Basilar artery
• Posterior cerebral artery

Question 8

Week 202 - Stroke: Describe the part of the brain that is supplied by the Anterior cerebral artery.

Answer 8

• The medial part of the hemispheres ( A strip that runs along the middle of the brain).

Question 9

Week 202 - Stroke: Describe the part of the brain that is supplied by the middle cerebral artery.

Answer 9

• The lateral part of the hemispheres, i.e. the temporal and parietal parts.

Question 10

Week 202 - Stroke: Describe which part of the brain is supplied by the posterior cerebral artery.

Answer 10

• The occipital part.

Question 11

Week 202 - Stroke: A Typical stroke, Infarction of the left cerebral artery affecting the left cerebral hemisphere motor and language areas. What would the clinical picture be?

Answer 11

• Acute Right hemiparesis and dysphasia. (FAST)

* No loss of consciousness.

Question 12

Week 202 - Stroke: What is the typical clinical picture of a primary intracranial haemorrhage (PICH)? And what is a typical triggering factor for this type of stroke?

Answer 12

• Very acute, hemi-anaesthesia, +/- loss of consciousness, +/- raised intracranial pressure.
• Typically a hypertensive patient / anti-coagulated.

Question 13

Week 202 - Stroke: What is the typically presentation of a sub-arachnoid haemorrhage?

Answer 13

• Sudden hemi-anaesthesia, meningism and loss of consciousness.

Question 14

Week 202 - Stroke: How is the demographic for Cerebral venous sinus thrombosis different from that of other strokes?

Answer 14

• It occurs at a younger age.

Question 15

Week 202 - Stroke: If you were to have a brainstem or spinal stroke, what would the clinical presentation be?

Answer 15

• Ataxia, Diplopia, Dysarthria, Lower cranial nerves, hemiparesis.

Question 16

Week 202 - Stroke: What is the ABCD2 scoring system for TIAs?

Answer 16

A - Age greater than 60
B - Blood Pressure >140/90
C - Clinical features - Unilateral weakness - 2 points
- Speech disturbance without weakness -1 point.
D - Duration ->60min - 2 points, 10-60min - 1 point
D- Diabetes

• High risk patients (6/7 points) have an 8% risk of two-day recurrent stroke.