2. Stroke

Question 1

What is a stroke?

Answer 1

Sudden neurological event of vascular origin

Question 2

What is a TIA?

Answer 2

Transient Ischaemic Attack

Signs and symptoms of stroke but resolves in less than 24 hours

Question 3

What is a CVA?

Answer 3

Sudden death of brain cells due to a lack of oxygen

Infarction is due to either ischaemia or haemorrhage

Question 4

Where do emboli tend to lodge?

Answer 4

Points of stenosis eg. atherosclerosis

Bifurcation of vessels

Question 5

Classify the causes of strokes

Answer 5

Atherosclerosis
Small vessel disease
Cardioembolism
Other
Dissection

Question 6

What are the causes of dissection?

Answer 6

Trauma, RTA

Fibromuscular dysplasia

Question 7

What additional symptoms can be caused by dissection?

Answer 7

Horner’s syndrome

Question 8

What are the risk factors that affect the vessel wall to cause an increased risk of stroke?

Answer 8

Hypertension
Smoking
Atherosclerosis
Hyperlipidaemia
Diabetes

Question 9

What are the causes of embolism resulting in stroke?

Answer 9

Coronary heart disease
Atrial fib
LV hypertrophy
Valve disease

Question 10

What radiology is the first to detect ischaemia?

Answer 10

MRI shows ischaemic change within mins

CT scan can exclude haemorrhage but takes 3 hours to become visible

Question 11

Which artery do perforating vessels arise from?

Answer 11

Middle cerebral artery

Question 12

Why are perforating vessels said to have a ‘design flaw’?

Answer 12

No collaterals

High pressure as no capillaries between arteries and veins

Question 13

What name is given to aneurysm formation in perforating vessels?

Answer 13

Charcot-Bouchard

Question 14

How does small vessel disease appear on radiology?

Answer 14

Ischaemic white change
Wide peri-vascular spaces
Old micro-haemorrhages showing as black spots
Deep white matter infarcts

Question 15

What disease is associated with berry aneurysms?

Answer 15

Polycystic kidney

Question 16

What are the main causes of haemorrhagic stroke?

Answer 16

Hypertension

Anti-coagulants

Question 17

Which parts of the brain are most likely to be affected by a hypertensive stroke?

Answer 17

Basal ganglia and thalamus as supplies by penetrating arteries

Question 18

Where are aneurysms most common?

Answer 18

Anterior circle of Willis

Question 19

What are the causes of intracerebral haemorrhage?

Answer 19

Hypertension and anticoags
Amyloid (alzheimers), aneurysms
Arteriovenous malformations
Tumours, trauma
Cocaine, cavernomas

Question 20

What symptom is associated with spontaneous subarachnoid haemorrhage?

Answer 20

Worst headache of your life

Question 21

What investigations should be done if a patient presents with ‘worst headache of their life’?

Answer 21

Neuro exam
Look for subarachnoid blood on CT
-yes: angio to find cause
-no: LP for xanthochromia (yellow CSF), then angio
Surgery or interventional radiology

Question 22

What group of patients is a decompressive craniectomy done in?

Answer 22

Young patients where high ICP isn’t controlled with other methods