STROKE

Question 1

symptoms of stroke?

Answer 1

Loss of motor function
Loss of speech- dysarthia/ dysphasia
Loss of sensation- numbness
Loss of vision- hemianopia

Question 2

Signs of STROKE

Answer 2

Clumsy speech, nonsense speech
gaze palsy
ataxia
nystagmus- wiggly eyes

Question 3

Name the two main causes

Answer 3

Haemorrhage- 15% - due to rupture of a blood vessel- can see blood on CT
Ischaemic stroke- Blockage of blood by thrombus/embolism

Question 4

What is the most common place for a clot to lodge?

Answer 4

the middle cerebral artery

Question 5

Name the two main sources of blood to the brain?

Answer 5

The vertebral arteries- posterior

The carotid arteries- anterior

Question 6

What stuctures do each blood vessels supply?

Answer 6

Vertebral- brainstem, cerebellum, occipital lobes

Carotids- most of cerebrum, deep white matter

Question 7

What does Wernicke’s area control?

Answer 7

Comprehension of speech

Question 8

What does Broca’s area control?

Answer 8

Makes sure that our speech makes sense

Question 9

Parietal lobe?

Answer 9

Language comprehension

Question 10

Temporal Lobe?

Answer 10

Emotional and personality

Question 11

Occipital lobes?

Answer 11

Vision

Question 12

What can happen if a clot appears in the deep white matter?

Answer 12

Lots of fibres within the pons so even a small stroke can cause locked in syndrome.

Question 13

How many subtypes of stroke?

Answer 13

4

Question 14

Name the most common type

Answer 14

PACS- partial anterior circulation
Occlusion is restricted to branches of the MCA
Mortality at 1 year= 16%

Question 15

Which has the highest mortality?

Answer 15

TACS- Total anterior circulation
60% mortality at 1 year.
occlusion of proximal MCA or ICA

Question 16

which type can be referred to as a silent stroke?

Answer 16

LACS- lacunar stroke

can be pure motor, pure sensory or ataxic hemiparesis

Question 17

Which stroke may occur if the patient presents with Bilateral Sensory/ motor deficit, isolated hemianopia, cranial nerve palsy or horners?

Answer 17

POCS- posterior circulation

affects brainstem, occipital lobes or cerebellum.

Question 18

Investigations?

Answer 18

Bloods- FBC, LIPIDS
ECG
CT
MRI
Carotid Doppler
ECHO- check for clot in heart.

Question 19

Treatment

Answer 19

Time Is BRAIN

thrombolysis - ALTEPLASE

Question 20

Problems with ALTEPLASE?

Answer 20

Can cause bleeding if brain is already damaged.

• only use if within 4.5 hours
• don’t use if recent bleed trauma or MI

Question 21

Other treatment?

Answer 21

Hemicraniectomy

• remove lid of skull
• allows decompression if cerebral oedema.

Question 22

What can stroke units offer?

Answer 22

• Can help mobilise patients
• help with swallowing
• physio

Question 23

Secondary prevention of stroke?

Answer 23

Clopidrogrel ( 75mg)
OR
ASA (75mg) + Dipyramide MR (200mg bd)
STATIN (even if no HTN)

Question 24

If carotid occlusion is over 70%?

Answer 24

carotid endarectomy to reduce risk of CVA.

Question 25

How do you know its not a TIA?

Answer 25

Symptoms lasting longer than 24hrs.