Week 3 - Stroke 2

Question 1

What causes symptoms of stroke?

Answer 1

loss of brain function

Question 2

What are common symptoms of stroke?

Answer 2

speech, feeling, weak limbs, vision, gaze palsy,

Question 3

What are common symptoms if cerebellum and brainstem are effected?

Answer 3

• ataxia,
• nystagmus of eyes,
• lack of coordination,
• dizziness
• pons damage

Question 4

What are common symptoms if anterior cerebral arteries are effected?

Answer 4

affects frontal lobe. paralysis of lower limbs, no sensory input.

Question 5

What are common symptoms if middle cerebral arteries are effected?

Answer 5

paralysis of face, arms and legs.
occipital lobe damage

if its on dominant side (left), you get aphasia. if its on non-dominant side (right), you develop neglect - unawareness of external space (only notice things on right)

Question 6

What are common symptoms if small vessel/lacunar arteries are effected?

Answer 6

deep matter small area affected. can have huge impact if its in the internal capsule - area with many neurons running together.
They can cause deficits including pure sensory, pure motor, sensorimotor or ataxic hemiparesis.

Question 7

What are common symptoms if posterior cerebral arteries are effected?

Answer 7

cerebellum and brainstem. can cause coma.

pons damage can lead to full paralysis except for eye.

temporal affected - hearing

occipital affected - vision

Question 8

What are the 4 kinds of stroke?

Answer 8

TACS - total anterior (and middle) cerebral stroke
PACS - partial anterior (and middle) cerebral stroke
LACS - lacunar stroke
POCS - posterior cerebral stroke

Question 9

Which kind of stroke has the highest mortality and recurrence rates?

Answer 9

Highest mortality is TACS. Highest recurrence is POCS

Question 10

What is the survival rate of stroke?

Answer 10

1/3 die in a year

Question 11

What damage is done after stroke?

Answer 11

50% dependant
60% unable to walk
40% unable to lift both arms
40% confused
30% unable to talk

Question 12

What are non-modifiable risk factors for stroke?

Answer 12

co-morbidities.

• BP,
• previous stroke,
• heart issues,
• peripheral vascular disease,
• reno-vascular disease,
• carotid disease,
• hyper-coagulable state
• diabetes

Question 13

What are modifiable risk factors for stroke?

Answer 13

• smoking,
• hypertension,
• diet,
• high LDL,
• alcohol,
• oral contraceptives,

Question 14

What are the aims of treatment? (3)

Answer 14

• protect brain before necrosis,
• remove clot,
• prevent clot occuring in first place

Question 15

What is the purpose of acute stroke therapy?

Answer 15

restore blood supply, prevent extension of damage and prevents re-perfusion injury

Question 16

What thrombolysis drug is used? what time frame?

Answer 16

alteplase - no more than 4.5 hrs

Question 17

Whats the pattern with how soon to give thrombolysis and the benefit?

Answer 17

sooner its given the more benefit outweighs the harm. after 4.5hrs, harm to patient (bleeding out) outweighs benefit so not given

Question 18

What other treatments aside from thrombolysis should be given to prevent/manage stroke?

Answer 18

anti-platelets, statins, blood pressure management (ACE’s, CCB’s)

Question 19

How do you treat a primary intercerebral haemorrhage?

Answer 19

no treatment - just get blood pressure down

Question 20

What scanning methods are used for detecting stroke and which is the best?

Answer 20

CT, MRI, Perfusion CT, CT angiogram

CT used over MRI as its faster and time is of the essence, MRI is more specific and perfusion CT is advanced and very helpful - take 30 mins compared to 5.

Question 21

What are issues with scanning techniques?

Answer 21

CT radiation - can lead to hair loss
MRI takes a while and is highly magnetic - dangerous

Question 22

What does a perfusion CT show?

Answer 22

highlights dead area and hypoxic areas to show degree of damage.

Question 23

What does a CT angiogram show? Do we use these?

Answer 23

vessel occlusion. quite fast so done often.

Question 24

Are strokes painful?

Answer 24

most strokes are painless. Haemorrhagic strokes are more likely to be painful, as blood is highly irritant to the meninges.

Question 25

What are 2 different types of dysphagia?

Answer 25

expressive dysphagia - brocas area damaged. knows what they want to say but cant get the words out

receptive dysphagia - wernickes area. speaks well but cant understand language

Question 26

What vision loss can be found in middle cerebral artery stroke?

Answer 26

homonymous hemianopia - half visual field in both eyes (2 left halves e.g.)

Question 27

What is dysarthria?

Answer 27

slurred speech due to motor deficit - weakening of muscle

Question 28

hemiplegia vs paraplegia?

Answer 28

• hemiplegia is paralysis in one side of the body
• paraplegia is paralysis in the lower limbs

Question 29

What vision loss does MCA lead to?

Answer 29

homonymous hemianopia