Stroke W4

Question 1

stroke definition?

Answer 1

sudden-onset focal neurological dysfunction due to vascular disease
neurological emergency!!!!!!!

Question 2

2 types of stroke?

Answer 2

ischaemic (80%)
haemorrhagic (20%)

Question 3

what is ischaemic stroke

Answer 3

blockage in arterial supply leads to tissue infarction

Question 4

what is intracerebral haemorrhagic stroke?

Answer 4

direct bleeding into brain parenchyma

Question 5

2 other types of stoke separate to ischaemic/haemorrhagic?

Answer 5

subarachnoid haemorrhage (due to aneurysmal rupture)
cerebral venous thrombosis

Question 6

blood supply to brain - anterior, middle, posterior cerebral arteries supply which areas?

Answer 6

anterior - medial (frontal, parietal)
middle - lateral (frontal, parietal, temporal)
posterior - (occipital, temporal)

Question 7

major risk factors of stoke?

Answer 7

ageing
vascular risk factors
cardiac pathology - emboli travel from heart

Question 8

vascular risk factors for stroke?

Answer 8

hypertension
smoking
diabetes
hypercholesterolaemia

Question 9

cardiac pathology risk factors for stoke?

Answer 9

atrial fibrillation
valvular disease
defects

Question 10

clinical features of stroke

Answer 10

sudden-onset
focal - features reflect area affected
75% anterior circulation
25% posterior circulation

Question 11

clinical features of anterior stroke?

Answer 11

cortical deficits (dysphasia, neglect, visual field deficits)
motor weakness, sensory disturbance

Question 12

types of dysphasia?

Answer 12

expressive - patients struggle to express themselves in words and writing
receptive - patients struggle to understand things said to them, follow commands

Question 13

clinical features of posterior stroke?

Answer 13

ataxia
diplopia
weakness and sensory disturbance

Question 14

diplopia?

Answer 14

double vision

Question 15

schema which is used clinically to classify stokes?

Answer 15

Bamford classification

Question 16

4 types of stroke in Bamford classification?

Answer 16

total anterior circulation stroke (TACS)
partial anterior circulation stroke (PACS)
lacunar stroke (LACS)
posterior circulation stroke (POCS)

Question 17

total anterior circulation stroke (TACS) location, vessel, and frequency?

Answer 17

large cortical stroke
anterior/middle cerebral arteries
15%

Question 18

total anterior circulation stroke (TACS) criteria?

Answer 18

unilateral weakness and/or sensory deficit of the face and/or arms and/or legs
homonymous hemianopia
higher cerebral dysfunction

Question 19

partial anterior circulation stroke (PACS) location, vessel, frequency?

Answer 19

cortical stroke
anterior or middle cerebral arteries
35%

Question 20

partial anterior circulation stroke criteria?

Answer 20

2/3 TACS criteria

Question 21

lacunar stroke (LACS) location, vessel, frequency?

Answer 21

subcortical stroke
small deep perforating arteries
25%

Question 22

lacunar stroke (LACS) criteria?

Answer 22

pure motor, sensory or sensorimotor (min 2: face, arm, leg)
ataxic hemiparesis

Question 23

posterior circulation stroke (POCS) location, vessel, frequency?

Answer 23

cortical, cerebellum, brainstem stroke
posterior cerebral, vertebral, basilar arteries and branches
25%

Question 24

posterior circulation stroke (POCS) criteria?

Answer 24

cerebellar or brainstem syndrome
loss of consciousness
isolated homonymous hemianopia

Question 25

homonymous hemianopia?

Answer 25

field loss deficit in same halves of the visual field of each eye

Question 26

transient ischaemic attack (TIA) definition?

Answer 26

symptoms and signs of ischaemic stroke but resolving (hence transient)
most resolves within minutes, by definition all resolve within 24 hours

Question 27

TIA imaging features?

Answer 27

if there is evidence of cerebral infarction then its not a TIA - its a stroke!! (even if clinical features have resolved)

Question 28

what does a TIA indicate?

Answer 28

warning sign - patient at elevated risk of ischaemic stroke in next few weeks - opportunity to intervene and reduce risk

Question 29

management of stroke - 3 categories?

Answer 29

hyperacute
secondary prevention
supportive care and rehab

Question 30

hyperacute management of ischaemic stroke?

Answer 30

reperfusion therapy:
thrombolysis (‘clot-busting’ medication)
thrombectomy (‘clot retrieval’ intervention)

both reduce long term disability after ischaemic stroke. time dependant!!!!

Question 31

hyperacute management of haemorrhagic stroke?

Answer 31

control BP and coagulation issues (eg due to medication like warfarin)

Question 32

secondary prevention management for ischaemic stroke?

Answer 32

antiplatelet therapy (300mg aspirin for 2 weeks, then low lose clopidogrel for life)
screen for and treat atrial fibrillation (all patients should have ECG)
surgery for carotid artery disease if present

Question 33

secondary prevention management for ischaemic and haemorrhagic stroke

Answer 33

BP control
lipid lowering
lifestyle (diet, exercise, weight loss, smoking cessation)

Question 34

supportive management for stroke?

Answer 34

dysphagia (unsafe swallow) - NG/PEG feeding, modified diets, speech & language therapy
dysphasia - communication aids, SLT
mobility - rehabilitation
cognition - supportive strategies
spasticity and contractures
pain
psychological support