202 Stroke

Question 0

What is the definition of a TIA?

Answer 0

Neurovascular event of cerebral hypoperfusion with symptoms which last <24hrs

Question 1

What percentage of strokes are ischaemic?

Answer 1

85%

Question 2

Which artery commonly infarcts in stroke?

Answer 2

Middle cerebral artery

Question 3

What would a stroke in the left occipital lobe cause?

Answer 3

Right homonymous hemianopia

Question 4

What would a stroke in the right thalamus cause?

Answer 4

Left hemianaesthesia

Question 5

What kind of symptoms would an intracranial haemorrhage in the left hemisphere produce?

Answer 5

Right hemiparesis

Question 6

What is Cushing’s triad?

Answer 6

Sign of raised ICP - suggests cerebral haemorrhage in trauma or a space occupying lesion.

1. Change in resps - often irregular or deep
2. Bradycardia
3. Widening pulse pressure

Question 7

What are the symptoms of a sub arachnoid haemorrhage?

Answer 7

Sudden thunderclap headache, meningism, loss of consiousness

Question 8

What are the features of a CVST?

Answer 8

Cerebral venous sinus thrombosis - I.e. DVT of the brain.
Raised ICP
No respect of arterial territories
Usually happens in the young

Question 9

What is the usual cause of TIAs?

Answer 9

Carotid emboli

Question 10

What is amaurosis fugax?

Answer 10

Curtain-like loss of vision in one eye due to passage of an embolus through the retinal artery

Question 11

What is the most modifiable risk factor for stroke?

Answer 11

Blood pressure

Question 12

What is the ROSIER system?

Answer 12

Recognition of a stroke in the emergency room

Sensitivity >90%, specificity >80%

Question 13

What is the most common cause of an ischaemic stroke?

Answer 13

Atrial fibrillation causing thrombus in dilated left atrium

Question 14

What causes stroke in a person with patent foramen ovale?

Answer 14

Valsalva manoeuvre - shunting causing clots to move from right atrium into left atrium

Question 15

Which circulation is affected given the following symptoms:
Amaurosis fugax
Aphasia
Hemiparesis 
Hemisensory loss
Hemianopia visual loss

Answer 15

Anterior circulation

Question 16

Which arteries make up the anterior circulation of the brain?

Answer 16

Internal carotids
Anterior cerebral
Middle cerebral

Question 17

Which arterial system of the brain is affected with any of the following:

Diplopia, vertigo, vomiting
Choking and dysarthria
Ataxia
Hemisensory loss
Bilateral visual loss
Tetraplasia

Answer 17

Posterior circulation i.e. Vestibulobasilar system

Question 18

Which arteries make up the posterior circulation of the brain?

Answer 18

Vertebral arteries
Basilar arteries
Posterior cerebral arteries
Posterior communicating arteries

Question 19

Disease of connective tissue is a predisposing factor for carotid and vertebral artery dissection?

Answer 19

Marfans

Question 20

Which 5 investigations should be performed when suspecting stroke?

Answer 20

Bloods: FBC, ESR, Glu, Lipids
BP
ECG
CXR
Cerebral imaging

Question 21

What are the specific investigations of a stroke?

6 listed

Answer 21

USS Carotids
CT/MRI angiography or venography
Catheter angiogram

Question 22

What is the initial treatment for an ischaemic stroke?

Answer 22

Thrombolysis <3 hours post onset of symptoms

Question 23

What are the 5 causes of ischaemic stroke?

Answer 23

Thrombus
Large artery stenosis
Small vessel disease
Cardio embolic
Hypoperfusion

Question 24

What are the 2 types of haemorrhagic stroke?

Answer 24

Intracranial haemorrhage | Subarachnoid haemorrhage

Question 25

What is ischaemic penumbra?

Answer 25

e.g. In stroke where the infarcted region is surrounded by a swollen area which does not function but is structurally intact - regain of function happens when there is neurological recovery

Question 26

What is the cause of neuronal cell death in a stroke?

Answer 26

Hypoxia leading to fall in ATP with release of glutamate which opens up calcium channels with release of free radicals. Leads to inflammatory damage, necrosis and apoptotic cell death

Question 27

Where is stroke typically seen?

Answer 27

Infarction in internal capsule following thromboembolism in middle cerebral artery branch

Question 28

What are the clinical features of a thromboembolus in the right middle cerebral artery?

Answer 28

Left limb weakness develops over seconds/mins/hours Contralateral hemiplegia/hemiparesis with facial weakness Aphasia Extensor plantar response

Question 29

What are lacunar infarcts?

Answer 29

``` Small infarcts seen on CT/MRI/autopsy Causes: Pure motor stroke Pure sensory stroke Sudden unilateral ataxia and sudden dysarthria with clumsy hand ```

Question 30

Definition of ataxia?

Answer 30

Loss of full control of body movements

Question 31

Define aphasia

Answer 31

Inability to nudist and or produce speech

Question 32

Define dysarthria

Answer 32

Difficult or unclear articulation of speech that is otherwise linguistically normal

Question 33

Define dysphagia

Answer 33

Difficulty/discomfort swallowing

Question 34

Define hemiparesis

Answer 34

Paralysis of one side of the body

Question 35

What is papilloedema a sign of?

Answer 35

Encephalopathy

Question 36

Define: hemianopia

Answer 36

Blindness over half the field of vision

Question 37

What is alteplase?

Answer 37

Recombinant tissue plasminogen activator - it generates plasmin which is one of the key enzymes of fibrinolytic pathway. Increased activity causes hyperfibrinolysis

Question 38

What is the long term management for a stroke?

Answer 38

Identify and address R/F: Antihypertensive Rx Antiplatelet Rx - long term aspirin/clopidogrel Anticoagulants - heparin/warfarin when there is AF Rehabilitation

Question 39

What are the risks of using anticoagulants such as heparin and warfarin too soon following an infarction?

Answer 39

Risk of provoking cerebral haemorrhage

Question 40

Why is physio important in the first few weeks following stroke?

Answer 40

Reduce spasticity Prevent contractures Teach use of walking aids

Question 41

What is the 2 year mortality of a stroke?

Answer 41

25%

Question 42

Is early mortality more common in thromboembolitic or haemorrhagic strokes?

Answer 42

Haemorrhagic

Question 43

What are the surgical options for treatment of stroke?

Answer 43

Carotid endarterectomy | Stenting of carotids