Stroke

Question 1

Definition of stroke

Answer 1

Sudden focal/global cerebral deficit, vascular origin, lasting >24h

Question 2

Predominant type of stroke

Answer 2

85% of all strokes are ischaemic

Can be thrombotic or embolic

Caused by:
Small vessel disease
Large Artery Atherosclerosis
Cardio-embolic stroke (AFib)
Cryptogenic stroke (unknown)

Question 3

Transient Ischaemic Attack

Answer 3

‘Mini’ stroke

Brief episode of neurological disfunction with clinical symptoms lasting <24 hours

Same mechanism as ischaemic strokes (same risk factors & symptoms)

Question 4

Less common type of stroke

Answer 4

Haemorrhagic stroke - caused by rupture of an artery in or on the brain

Question 5

Symptoms of haemorrhagic strokes

Answer 5

Headache
Nausea
Vomiting
Reduced Consciousness
Weakness in one part of the body

Question 6

Mortality of haemorrhagic stroke (vaguely)

Answer 6

High mortality

Question 7

FAST

Answer 7

Face (weakness/droopiness)
Arms (inability to keep both arms up; weakness/numbness in one)
Speech (Slurred; may also struggle to understand)
Time (ACT FAST)

Question 8

Non-modifiable Risk Factors of Stroke

Answer 8

Age - Usually above 55 yo
Sex - More common in men
Ethnicity - South Asian, African or Caribbean more likely
Family history
Previous ischaemic stroke or TIA

Question 9

Medical risk factors of stroke

Answer 9

Hypertension
Diabetes
Hyperlipdaemia
CVD (e.g. AFib)
Haematological Issues
Inflammatory Issues
HRT

Question 10

Social risk factors of stroke

Answer 10

Smoking
Alcohol
Oral Contraceptive use

Question 11

Why does AFib increase stroke risk

Answer 11

It allows blood to slow down or pool, increasing stroke risk (5-fold increase)

Question 12

Types of AFib

Answer 12

Paroxysmal AF: Episodes come and go, usually stopping within 48h without treatment
Persistent AF: Each episode lasts longer than 7 days (when untreated)
Long-standing persistent AF: Continuous AF for a year or longer

Permanent AF

PAROT PERSISTENT, LONG STANDING? PERMANENT!!
idk it makes sense to me

Question 13

Symptoms of stroke

Answer 13

Sudden weakness in face/arm/leg on one side

Speech issues

Vision problems in one or both eyes; uncontrolled eye/eyelid movements

Sudden loss of balance and coordination

Sudden difficulty swallowing; drooling

Memory loss

Personality and mood changes

Question 14

Diagnosis of Stroke

Answer 14

Physical Exam/Medical History

BP, HR and Cholesterol/Sugar Checks

Neurological Exam; signs and symptoms; location/size of damage

Question 15

CT Scans of Ischaemic Stroke and Haemorrhagic Stroke (Just for awareness)

Answer 15

Question 16

Factors affecting stroke prognosis

Answer 16

Location of damage
Size of damage
Comorbidities
Possibility of stroke recurrence

Question 17

Treatment of Ischaemic Stroke

Answer 17

Recombinant tissue plasminogen activator (Alteplase) (short therapeutic window)

Mechanical thrombectomy

Carotid endarterectomy (surgery removing carotid plaque)

Question 18

Treatment of Haemorrhagic Stroke

Answer 18

No medical therapy - treat hypertension or sugery to stop/prevent bleeding

Question 19

Prevention of stroke

Answer 19

Control BP (ACE inhibitors)
Lower cholesterol (Statin)
Control diabetes
Quit smoking
Maintain healthy weight/lifestyle (Diet/Exercise)
Manage stress