Cerebral infarction (clinical)

Question 1

Define stroke

Answer 1

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

Question 2

Are most strokes ischaemic or haemorrhagic?

Answer 2

ischaemic

Question 3

Define transient ischaemic attack

Answer 3

Symptoms resolve within 24 hours and usually within 1-60mins

Question 4

Some causes of ischaemic stroke

Answer 4

large artery atherosclerosis 
small artery occlusion - lacunar 
cardioembolic eg AF
undetermined/cryptogenic 
rare eg arterial dissection

Question 5

Haemorrhagic stroke causes

Answer 5

primary intracerebral haemorrhage

secondary eg subarachnoid haemorrhage or arteriovenous malformation

Question 6

Is MRI or CT preferred in stroke?

Answer 6

CT

Question 7

Ischaemia

Answer 7

Failure of cerebral blood flow to part of the brain caused by interruption of blood supply to brain

Question 8

Why is hypoxia clinically important in stroke?

Answer 8

stresses cell metabolism
can lead to anoxia and infarction/necrosis
penumbra

Question 9

What is the penumbra?

Answer 9

Area surrounding ischaemic event

Question 10

What can further damage in a stroke result from?

Answer 10

oedema

secondary haemorrhage into stroke

Question 11

Modifiable risk factors of stroke

Answer 11

hypertension
smoking
diet/alcohol/lifestyle
diabetes

Question 12

Non modifiable risk factors of stroke

Answer 12

male
age
family history
previous stroke

Question 13

What can chronic hypertension cause in relation to stroke?

Answer 13

worsens atheroma

affects small distal arteries

Question 14

Small artery lipohyalinosis - what is it?

Answer 14

build up of vessel wall - aneurysm and microclots

Question 15

Some other risk factors for stroke

Answer 15

OCP/HRT - oestrogen
impaired cardiac function
malignancy
genetic

Question 16

Anterior circulation to brain

Answer 16

2 ICA –> 2 ACA and 2 MCA

Question 17

Posterior circulation to brain

Answer 17

2 vertebral –> 1 basilar
3 pairs of cerebellar arteries
2 PCA

Question 18

2 connections of arterial blood supply in the brain

Answer 18

circle of willis - anterior and posterior communicating arteries
borderzone anastomoses - between peripheral branches of cerebral arteries

Question 19

symptoms of ACA occlusion (contralateral - 3)

Answer 19

paralysis of foot and leg
sensory loss over foot and leg
impairment of gait and stance

Question 20

Symptoms of MCA occlusion (contralateral and others)

Answer 20

contralateral - paralysis of face, arm, leg
sensory loss of face, arm, leg
homonymous hemianopia
gaze paralysis to opposite side
aphasia if stroke on left side
unilateral neglect and agnosia if on right side

Question 21

Agnosia

Answer 21

Inability to process sensory information

Question 22

3 signs left hemisphere is affected

Answer 22

hemiplegia
homonymous hemianopia
dysphasia

Question 23

3 signs right hemisphere is affected

Answer 23

left hemiplegia
left homonymous hemianopia
agnosia

Question 24

4 agnosias if right side of brain affected

Answer 24

visual
sensory
anosagnosia
prosopagnosia

Question 25

anosagnosia

Answer 25

denying of hemiplegia

Question 26

prosopagnosia

Answer 26

failure to recognise faces

Question 27

What are lacunar strokes devoid of?

Answer 27

cortical signs eg dysphasia, hemianopia

Question 28

Anatomy within posterior circulation of brain

Answer 28

brainstem, cerebellum, thalamus | occipital and medial temporal lobes

Question 29

List some symptoms of brainstem dysfunction

Answer 29

coma, vertigo, nausea, vomiting, ataxia, cranial nerve palsy, hemiparesis, visual field defects

Question 30

3 aims of acute ischaemic stroke therapies

Answer 30

restore blood supply prevent extension of ischaemic damage protect vulnerable brain tissue

Question 31

List some potential treatments used in stroke

Answer 31

aspirin, heparin, tPA, thrombectomy, neuroprotectant

Question 32

List some of the staff in stroke units

Answer 32

OT, SLT, physiotherapist, stroke nurses, dietician, psychologist, orthopist, clinical staff

Question 33

Orthopist?

Answer 33

For double vision

Question 34

4 types of stroke

Answer 34

TACS PACS LACS POCS

Question 35

Which is the most devastating stroke?

Answer 35

TACS

Question 36

What are the MUSTS when using TPA

Answer 36

consent symptoms present more than 60 mins but less than 4.5 hours disabling neurological deficit

Question 37

Contraindications for TPA use

Answer 37

``` blood on CT coagulation problems recurrent bleeding recent surgery high bp glucose too high or low ```

Question 38

Investigations of stroke

Answer 38

``` blood - FBC, ESR, glucose, lipids CT/MRI ECG Echo carotid Doppler ultrasound cerebral angiogram/venogram hypercoagulable blood screen ```

Question 39

Mural thrombus

Answer 39

thrombus formed in heart chamber

Question 40

atrial myxoma

Answer 40

non cancerous tumour in heart

Question 41

Giant cell arteritis - investigation

Answer 41

tender over temporalis | ESR, temporal artery biopsy

Question 42

secondary prevention of stroke

Answer 42

``` anti-hypertensives lipid lowering agents anti-platelets warfarin carotid endartectomy ```

Question 43

Some other conditions that look like stroke but aren't

Answer 43

bells palsy migraine hypoglycaemia

Question 44

Management and aims of care

Answer 44

``` rehab and reintegration quality of life knowledge and improve psychological status prevent recurrance reduce mortality and disability ```