Acute Ischaemic Stroke

Question 1

What is the current approach to management of ischemic stroke

Answer 1

Primary prevention: reducing risk factors etc.
Acute phase: reperfusion, neuroprotection
Recovery: functional and cognitive, neuroreperation

Question 2

True or false: treatment is time dependant

Answer 2

True

Question 3

What treatment is associated with improved long term survival and functional status after ischemic stroke

Answer 3

Thrombolysis with intravenous alteplase

Question 4

Why is thrombolysis an effective treatment

Answer 4

Stroke is caused by a clot in the artery so thrombolysis breaks down the clot

Question 5

Name another, quite expensive, treatment

Answer 5

Endovascular thrombectomy, some case studies have shown earlier treatment with ET and medical therapy compared to medical therapy alone, was associated with lower degrees of disability at 3 months.

Question 6

True or false: there’s an age limit of endovascular thrombectomy

Answer 6

False. Every patient has their own course of infarct evolution so prior state matters more

Question 7

Why are reperfusion therapies still used for AI stroke if only 10-20% of patients benefit

Answer 7

Because they open a new field for neurorepair therapies

Question 8

What outperforms alteplase for stroke thrombolysis

Answer 8

Tenecteplase

Question 9

Why does tenecteplase outperform alteplase

Answer 9

It’s cheaper, provides more ignition reperfusion at initial analogram, improved functional outcomes, convenience of single bolus and no safety concerns

Question 10

Intravenous treatment can be done up to 4 hours after stroke, how long can a thrombectomy be done after?

Answer 10

7.3 hours

Question 11

What is a Code Stroke in the hospital

Answer 11

• All conditions of pt. established in emergency box
• Nurses and doctors attend to stabilise
• Move pt. to CT scan
• Differentiate type of stroke e.g. ischemic or haemorrhagic

Question 12

How long can brain tissue stay alive for after losing sufficient blood flow

Answer 12

2-3h

Question 13

What is the penumbra

Answer 13

The region around the infarctocore with more blood flow

Question 14

What is oligaemia

Answer 14

The reduction of blood flow to a tissue, oligaemia is the step down from penumbra, surrounds the areas of penumbra but with more blood flow

Question 15

What is one of the mechanisms for auto regulation/compensation after occlusion

Answer 15

Capillary vasodilation - cerebral blood volume stabilises or increases, blood cerebral flow decreases

Question 16

Why are autoregulatory compensation mechanisms not always enough

Answer 16

They’re insufficient and stop eventually, CBF decreases too much causing protein synthesis to stop, electrical activity and eventually, irreversible damage

Question 17

What is the baseline CT scan useful for in AIS

Answer 17

Ruling out haemorrhage
Rule out other minor strokes eg tumour
Assess early signs of stroke

Question 18

What is the CT perfusion helpful for

Answer 18

Quantify the extent of

• infarcted ischemic tissue
• tissue at risk of penumbra potentially recoverable
• better selection of candidate for advanced treatments

Question 19

What is CT-angiography useful for in AIS analysis

Answer 19

Intra and extracranial circulation

Shows is Thrombectomy necessary

Question 20

Why does sever Alzheimer’s result in physically in the brain

Answer 20

Severe atrophy

Question 21

What is biological marker (not a guarantee) for future onset of Alzheimer’s disease

Answer 21

Deposits of beta amyloid in the brain