Cerebral Infarction

Question 1

What is a big prognostic factor in stroke?

Answer 1

Ageing

Question 2

What is a stroke?

Answer 2

Sudden onset of focal or global neurological symptoms caused by ischaemia or haemorrhage and lasting >24 hours

Question 3

What % of strokes are ischaemic

Answer 3

85%

Question 4

What % of strokes are hemorrhagic?

Answer 4

15%

Question 5

What is a TIA?

Answer 5

Mini stroke

Symptoms resolve within 24 hours

Question 6

What does stroke risk increase with?

Answer 6

Age

Question 7

What is the FAST approach?

Answer 7

Facial weakness
Arm weakness
Speech
Time - call 999

Question 8

Why are MRI’s not often used as imaging even though they are better for imaging strokes?

Answer 8

Because they take time

And are impractical for such an acute situation

Question 9

How does blood show on CT?

Answer 9

White

Question 10

Why is CT good for imaging stroke?

Answer 10

Blood shows up white

Good for distinguishing ischaemic and haemorrhagic

Question 11

What causes ischaemic stroke?

Answer 11

Failure of cerebral blood flow to a part of the brain

Interruption of the blood supply to the brain

Question 12

What is anoxia?

Answer 12

No oxgen

Question 13

What are the non-modifiable risk factors for stroke?

Answer 13

Previous stroke
Being old
Male
Bad FH

Question 14

What is the most important modifiable risk factor for stroke?

Answer 14

Hypertension

Question 15

What are the modifiable risk factors for stroke?

Answer 15

Hypertension 
High lipid levels 
Alcohol and obesity 
Smoking
DM

Question 16

What is necrosis?

Answer 16

Cell death

Question 17

What effect does chronic hypertension have of the brain?

Answer 17

Worsens atheroma

Affect small distal arteries

Question 18

By what fold does DM increase the incidence of stroke?

Answer 18

By 3 fold

Question 19

By what fold does smoking increase the incidence of cerebral infarction?

Answer 19

2 fold

Question 20

By what fold does smoking increase the incidence of sub-arachnoid haemorrhage?

Answer 20

3 fold

Question 21

Which factors contribute to LDL-C deposition in the arterial walls?

Answer 21

Hypertension
Smoking
DM

Question 22

How do small amounts of alcohol affect your stroke risk?

Answer 22

Decreases it

Question 23

How does heavy drinking affect you stroke risk?

Answer 23

Increases it

Question 24

Which OCP increases stroke risk?

Answer 24

Oestrogen content ones only

Question 25

Describe the anterior circulation of the brain

Answer 25

2x ICA 2x anterior cerebral artery 2x middle cerebral artery

Question 26

Describe the posterior circulation of the brain

Answer 26

2x vertebral arteries 3 pairs of cerebellar arteries 2x posterior cerebral arteries

Question 27

How is the anterior circulation of the brain connected to the posterior circulation of the brain?

Answer 27

By the circle of willis

Question 28

What are the symptoms of ACA occlusion?

Answer 28

Contralateral paralysis of foot and leg Sensory loss over foot and leg Impairment of gait and stance

Question 29

What are the symptoms of MCA occlusion?

Answer 29

``` Contra-lateral paralysis of face/arm/leg sensory loss face/arm/leg homonymous hemianopia Gaze paralysis to the opposite side Aphasia stroke - if on dominant side Unilateral neglect and agnosia for half of external space - non-dominant side ```

Question 30

Which type of stroke has the worst prognosis?

Answer 30

TACS

Question 31

What is TPA?

Answer 31

Tissue plasminogen activator

Question 32

What is the function of TPA?

Answer 32

Anticoagulant | Breaks down blood clots

Question 33

What is the cut off time of use of TPA?

Answer 33

<4.5 hours

Question 34

What is included in the exclusion criteria for IV TPA?

Answer 34

Anything that increases probability of haemorrhage i.e blood on CT, recent surgery, recent bleeding episode, coagulation problems BP >185 systolic or >110 diastolic Glucose <2.8 or >22 mmol/L

Question 35

Who are some of the member of the disciplinary team involved in dealing with stroke patients?

Answer 35

``` Clinical staff Stroke nurse Physio Speech and language therapist Occupational therapists Dietician Psychologists Orthoptist ```

Question 36

What is the treatment for stoke?

Answer 36

IV TPA Aspirin Thrombectomy

Question 37

What is TIA a warning sign of?

Answer 37

Stroke

Question 38

What blood test investigations are carried out for stroke?

Answer 38

FBC Glucose Lipids ESR

Question 39

What other investigations are carried out for stroke?

Answer 39

``` CT MRI ECG Echo Carotid doppler Cerebral angiogram Hyper-coagulable blood screen ```

Question 40

What treatments can be given as secondary prevention?

Answer 40

``` Anti-hypertensives Anti-platelets Lipid lowering drugs Warfarin for AF Carotid endarectomy ```