Stroke and Neurodegeneration (Dr TD Farr)

Question 1

What is stroke?

Answer 1

The acute onset of neurological defecits (lasting for more that 24h) due to disturbance in blood supply to the brain

Question 2

What are the neurological symptoms associated with stroke?

Answer 2

Aphasia - speech problem
Dysphasia - swallowing
Apraxia - control of speech
Hemiparesis - half-body paralysis
Facial weakness
Confusion, dizziness and vision impairments
Thunderclap headache (associated with hemorrhage)

24h symptoms (if less - TIA)
TIAs are often a sign that precedes a major stroke afterwards

Question 3

What are some non-modifiable stroke risk factors?

Answer 3

Age, race, genetics, gender (menopause - estrogen has a neuroprotective function so it is less likely in women before menopause then equally risky post menopause.)

Question 4

What are some of the modifiable risks associated with stroke?

Answer 4

Hypertension, smoking, diabetes, high cholesterol, obesity, activity levels.

Question 5

What are the two main types of stroke?

Answer 5

Ischaemic or Hemorrhagic

Question 6

What is the difference between an ischaemic stroke compared to a hemorrhagic stroke?

Answer 6

An ischemic stroke happens when a blood vessel (artery) supplying blood to an area of the brain becomes blocked by a blood clot. About 80 out of 100 strokes are ischemic strokes. A hemorrhagic stroke happens when an artery in the brain leaks or bursts (ruptures).

Question 7

What are the two types of hemorrhagic stroke?

Answer 7

Intracerebral and subarachnoid (subarachnoid, blood gets into the meninges and causes pressure)

Question 8

What are the two types of ischemic stroke?

Answer 8

Thrombotic and embolic
Thrombotic strokes are caused by a blood clot that develops in the blood vessels inside the brain. Embolic strokesare caused by a blood clot or plaque debris that develops elsewhere in the body and then travels to 1 of the blood vessels in the brain via the bloodstream.

Question 9

What does FAST stand for?

Answer 9

Facial weakness
Arm weakness
Speech difficulty
Time to call 999

Question 10

What are the two main types of artery that supply the brain?

Answer 10

Carotid arteries (forebrain)
Vertebral arteries (hindbrain)

Question 11

What is The Circle of Willis?

Answer 11

A major anastomosis for the brain
It is an arterial circle at the base of the brain and it can compensate for/minimise collateral damage when things go wrong in the circulation of the brain.

Question 12

What are the four main pairs of cerebral arteries?

Answer 12

Basilar artery (brain stem) and posterior cerebral arteries (medical occipital and inferior temporal lobe, hippocampus)

Anterior cerebral artery (medial frontal and superior parietal lobe, corpus callosum)

Middle cerebral arteries (lateral temporal and parietal lobes and posterior frontal lobe) and Lenticulostriate arteries (internal capsule and basal ganglia).

Question 13

What is an aneurism?

Answer 13

The most common cause of a hemorrhage is rupture of a saccular (berry) aneurism.
An excessive localised swelling of the wall of an artery

Question 14

What is aneurism coiling?

Answer 14

Clipping prevents blood going into the aneurism.
Coiling also stops the bursting of an aneurism.
Insert a microcanula and feed coil into aneurism

Question 15

What tests are used to diagnose a stroke?

Answer 15

ROSTIER; RecOgnition of Stroke In the Emergency Room (higher score = more serious)
ABCD (Age, Blood pressure, Clinical features, Duration, Diabetes)
CT Scan (Computed tomography)

Question 16

Are CT scans effective in detecting strokes?

Answer 16

CT is 40-60% successful in detecting acute ischaemic stroke; it is often not clear in CT scan results

Question 17

What are Hounsfield Units (HU)?

Answer 17

In the CT scan it shows the progression of basal ganglia deterioration
Density of color

Question 18

What is a better scan method for diagnosing an acute ischaemic stroke?

Answer 18

MRI

Diffusion weighted imaging

Question 19

What is the most common cause of hemorrhage?

Answer 19

Aneurism
Typically located near junction vessels
Anterior, middle, internal, basilar

Question 20

What are the three diagnosis tests that are used to diagnose each typeof stroke?

Answer 20

ROSTIER (acute classification)
ABCD (transient ischemic attack)
Hunt and Hass haemorrhage

Question 21

What are CT scans used for?

Answer 21

CT is used to rule out hemorrhage

Question 22

How can ischemic tissue become clear on a CT scan?

Answer 22

Becomes more dense over time / darker

Question 23

What is ‘The Penumbra’?

Answer 23

‘the partially shaded outer region of the shadow cast by an opaque object’
It represents potentially salvageable tissue
In ischemia it is the hallmark of a stroke and is why time is brain in a patient suffering a stroke.
If a stoke is not treated quickly then the penumbra is small.

Question 24

What is the only treatment for ischemic stroke?

Answer 24

Recombinant tissue plasminogen activator (rt-PA) (Alteplase) is the only treatment.
The window for Alteplase is 3h from symptom onset. (Thought to break up fibrogen in clot)?

Question 25

What is the pathophysiological overview of stroke?

Answer 25

DIAGRAM including excitatory pathway and inflammation