Stroke

Question 1

what are the 3 types of stroke

Answer 1

sudden onset
focal - features reflect affected area
cerebral dysfunction
stroke is a neurological emergency

Question 2

what are the mechanisms of stroke

Answer 2

ischaemic - blockage in arterial supply leads to tissue infarction (80%)
intracerebral haemorrhage - direct bleeding into brain parenchyma (20%)
subarachnoid haemorrhage (due to aneurysmal rupture) and cerebral venous thrombosis are two rarer mechanisms

Question 3

what are the risk factors for stroke

Answer 3

ageing
vascular risk factors (hypertension, smoking, diabetes, hypercholesteraemia)
cardiac pathology (atrial fibrillation, valvular disease, defects)

Question 4

what are the clinical features of an anterior stroke

Answer 4

75%
affect hemispheres, subcortical, basal ganglia
leads to cortical deficits such as dysphasia, neglect, visual field defects
can also lead to motor weakness and sensory disturbance
can be partial or total

Question 5

what are the clinical features of a posterior stroke

Answer 5

25%
affect brainstem, cerebellum, occipital lobes
can lead to ataxia, diplopia (double vision) and weakness and sensory distrubance

Question 6

what is a lacunar stroke

Answer 6

subcortical stroke
affects small deep perforating arteries
symptoms are pure motor, sensory or sensorimotor (min. 2 of face, arm, leg) and ataxic hemiparesis

Question 7

what arteries are affected in an anterior stroke

Answer 7

anterior or middle cerebral arteries

Question 8

what arteries are affected in a posterior stroke

Answer 8

posterior cerebral artery, vertebral artery, basilar artery and branches

Question 9

what is a transient ischaemic attack

Answer 9

symptoms and signs of ischaemic stroke but resolve within minutes (within 24hrs by definition)

Question 10

what does a TIA indicate

Answer 10

neurological emergency
elevated risk of ischaemic stroke in next few weeks
gives opportunity to intervene and reduce risk of stroke (screen for risk factors and manage these)

Question 11

describe hyperacute management of ischaemic stroke

Answer 11

possibility to offer reperfusion therapy, but it is time-dependent
thrombolysis (clot-busting medication)
thrombectomy (clot retrieval)
reduces long-term disability risk

Question 12

hyperacute management of haemorrhagic stroke

Answer 12

control BP and coagulation issues

Question 13

describe secondary prevention for ischaemic stroke

Answer 13

give antiplatelet (~300mg aspirin for 2 weeksm then low dose clopidogrel for life)
screen for atrial fibrillation (and treat if present), if carotid artery disease present they may be eligible for surgery (endarterectomy)

Question 14

secondary prevention in ischaemic and haemorrhagic stroke

Answer 14

control BP
lower lipids
lifestyle changes - diet, exercise, weight loss, smoking cessation

Question 15

what supportive management is provided

Answer 15

dysphagia (unsafe swallow) - NG or PEG feeding, modified diets, SLT
dysphasia - communication aids, SLT
mobility - rehabilitation (PT, OT)
cognition - supportive strategies
manage any secondary complications such as infection (esp pneumonia)