Cerebrovascular Disease

Question 1

What is a stroke?

Answer 1

A rapidly developed condition of focal/global loss of brain function.

Question 2

What is the most common cause of a stroke?

Answer 2

Infarction

Question 3

Asides from infarction, what are other causes of stroke?

Answer 3

Subarachnoid haemorrhage

Intracerebral haemorrhage

Question 4

What are the potential causes of a cerebral haemorrhage?

Answer 4

Hypertension
Amyloid angiopathy
Structural abnormality

Question 5

What is the first-line imaging in those suspected to have suffered a stroke?

Answer 5

CT brain

Can take time to appear in infarction (hyperacute scan will be normal).

Question 6

What form of imaging is second-line to CT scan in stroke?

Answer 6

MRI scan

Question 7

What is the aim of stroke treatment?

Answer 7

Reperfuse the affected tissue.

Time = Tissue.

Question 8

What 3 signs should be tested for in a suspected stroke?

Answer 8

Facial weakness
Arm weakness
Speech problems

Question 9

What is the main method of treatment in stroke?

Answer 9

Thrombolysis

Question 10

When is thrombolysis contraindicated?

Answer 10

Intracerebral haemorrhage
Atrophy
High BP
Diabetes

Question 11

Why should CT always be performed prior to thrombolysis therapy in suspected stroke?

Answer 11

To ensure causation is a clot and not a haemorrhage.

Question 12

What is endovascular therapy?

Answer 12

The physical removal of a clot. Does not involve any drug treatment.

Question 13

Should antiplatelets be given in stroke?

Answer 13

Yes

If thrombolysed, wait 24 hrs and CT scan for any damage prior to initiation.

Question 14

How should a mild stroke be managed long-term?

Answer 14

Aspirin and clopidogrel - 3 weeks.

Give a single antiplatelet therapy thereafter.

Question 15

What is used to prevent DVT in those immobilised by a stroke?

Answer 15

Intermittent pneumatic compression.

Question 16

What are TIAs?

Answer 16

Transient episodes of temporary arterial occlusion.

Lasts less than 24 hours.

Question 17

What is the difference between a stroke and a TIA?

Answer 17

Stroke lasts > 24 hours.

TIA lasts < 24 hours.

Question 18

When is a diagnosis of TIA made?

Answer 18

Following the cessation of symptoms.

Question 19

Why is it important to manage a TIA effectively?

Answer 19

It can lead to a stroke within a few days.

Question 20

How is a TIA investigated?

Answer 20

Carotid imaging
ECG
Blood tests

Question 21

How is a TIA managed?

Answer 21

Antiplatelet therapy

Statin therapy

Question 22

Should hypertension be treated in those with an infarct stroke?

Answer 22

No, as this may be the factor allowing the brain to be perfused.

Question 23

Should hypertension be treated when giving thrombolysis?

Answer 23

Yes, as this may result in haemorrhage.

Question 24

If systolic >150mmHg in case of primary intracerebral haemorrhage, what should be given?

Answer 24

Antihypertensives for atleast 7 days.

IV GTN can be used for rapid relief.

Question 25

What is used to reverse the effects of warfarin?

Answer 25

Vitamin K

Question 26

Where does an intracerebral haemorrhage occur?

Answer 26

Within the brain parenchyma.

Question 27

What is the most common cause of intracerebral haemorrhage?

Answer 27

Trauma.

Question 28

What is amyloid angiopathy?

Answer 28

The deposition of amyloid in the blood vessel walls, weakening them. This disrupts the blood brain barrier.

Question 29

Where are intracerebral haemorrhages linked to hypertension typically seen?

Answer 29

Basal ganglia

Question 30

What are focal symptoms seen in ICH?

Answer 30

``` Paresis Dysphagia/Aphagia Numbness Seizure Visual symptoms ```

Question 31

What are global symptoms seen in ICH?

Answer 31

Headache Nausea + Vomiting Reduced GCS Pupils

Question 32

How is ICH treated?

Answer 32

Surgery

Question 33

What are the 3 categories of the GCS?

Answer 33

Eye response Verbal response Motor response

Question 34

How is ICH diagnosed?

Answer 34

Digital subtraction angiography is gold standard.

Question 35

What do Hounslow's units differentiate between?

Answer 35

Calcium deposits and blood.

Question 36

Where is the most common area for a cerebral artery aneursym?

Answer 36

Anterior communicating artery

Question 37

What is the appearance of a cavernoma?

Answer 37

Has a characteristic 'pop-corn' appearance.

Question 38

What does haemosiderin presence indicate?

Answer 38

Multiple cavernoma