Peripheral Neuropathy And Guillan barre Syndrome,Cerebrovascular Accidents And Stroke

Question 1

What is peripheral neuropathy

The prevalence of neuropathy is estimated to be between 6% and 51% among adults especially those with diabetes.
•Depending on age, duration of diabetes, glucose control, type 1 and type 2 diabetes.
•The clinical manifestations are variable, ranging from asymptomatic to painful neuropathic symptoms.
True or false

What are the types of peripheral neuropathy

Answer 1

Peripheral Neuropathy is a disorder affecting motor, sensory or autonomic nerves.
•Refers to the weakness, numbness and pain from nerve damage usually in the hands or feets.

True

Neuropathies ae classified according to the problems they cause.They are:
•Mononeuropathy
•Polyneuropathy

Question 2

What is mononeuropathy
When does it occur
What is the most common cause of it
State four most common complaints of mononeuropathy

Answer 2

Damage to a single peripheral nerve is known as mononeuropathy.

Mononeuropathy occurs when myelin sheath or part of the nerve cell is damaged. The damage prevents nerves from spreading signals.
The most common cause is physical injury or trauma from an accident

. common complaints are;
•loss of feeling in the affected area
•weakness in the affected area
•Pain or burning sensations
•feeling of “pins and needles” etc

Question 3

Name four types of mononeuropathies

How does polyneuropathy occur

Polyneuropathy accounts for the greatest number of peripheral neuropathy cases. True or false

What is the most common form of chronic polyneuropathy

Answer 3

Carpel tunnel syndrome
•Ulnar nerve palsy
•Radial nerve palsy
•Tarsal tunnel syndrome
•Peroneal nerve palsy: The peroneal nerve is a branch of the sciatic nerve, which supplies movement and sensation to the lower leg, foot and toes. Common peroneal nerve dysfunction is a type of peripheral neuropathy (damage to nerves outside the brain or spinal cord). This condition can affect people of any age.

•It occurs when multiple peripheral nerves throughout the body malfunction at the same time causing weakness, numbness and burning pain
in roughly the same side of the body.

True

•One of the most common forms of chronic polyneuropathy is diabetic neuropathy.

Question 4

State four the causes of polyneuropathy

Answer 4

Idiopathic causes
•Age; over 40 years
•Acquired causes; environmental factors such as illness, trauma, toxins, etc
•Other causes are diabetes, alcoholism, under nutrition(vitamin B) , cancer and chemotherapy, other medications, etc.
•Hereditary; are not so common. Most common of these is Charcot-Marie tooth disease type 1

Question 5

What is the pathophysiology of polyneuropathy (state the three mechanisms that can lead to peripheral neuropathy apart from other causes and explain segmental demyelination

Answer 5

The exact pathophysiology is contingent on the underlying disease.
•Although there are other mechanisms that can lead to peripherial neuropathy.
•Segmental Demyelination
•Wallerian Degeneration
•Axonal Degeneration

Segmental Demyelination: process of degeneration of the myelin sheath, with sparing of the nerve axon.
•This type of reaction can present in mononeuropathies, sensory motor or principally motor neuropathies.
•These are often inflammatory and sometimes immune mediated.

Question 6

Explain wallerian degeneration ,what does it result in

Explain axonal degeneration (how it manifests,where it tends to cause weakness,)

Answer 6

Wallerian Degeneration: Occurs after a nerve axon degenerates due to lesion or physical compression, the portion distal to the axon passively wastes away, likely due to lack of nutrients from the cell body.
•This results in focal mononeuropathy that is secondary to trauma or infarction of the nerve.

This part usually manifests as symmetrical polyneuropathy and tend to cause weakness, most notably weakness in dorsiflexion of the ankles and foot, with accompanied trophic changes to muscle.
•The axon degenerates in a pattern that starts distally and progresses proximally. Because distal portion of the axon is vulnerable due to its distance from the cell body which provides metabolic support.

Question 7

What are the signs and symptoms of peripheral neuropathy
(State four things that occur when the sensory nerve is affected,state the initial symptoms,advanced symptoms and Landry paralysis)
What is Landry ascending paralysis

Answer 7

Depends upon the type of nerve affceted.
•When the sensory nerve is affected:
- Gradual onset of numbness
- Prickling or tingling in feet or hands, which can spread upward into legs and arms
- Sharp, throbbing or burning pain
- Extreme sensitivity to touch
- Pain during activities that should not cause pain

Initial symptoms:
•Back and limb pain
•Paresthesias or pins and needles(Tingling or prickling, “pins-and-needles” sensation; usually temporary, often occurs in the arms, hands, legs or feet.
) affecting distal extremities
•Advanced symptoms:
Ascending paralysis
- Bilateral flaccid paralysis(loose or floppy limbs)
- Spreads from the lower to the upper limbs
Landry paralysis:
- Involvement of the respiratory muscles - respiratory failure

Landry ascending paralysis: A particularly virulent form of Guillain-Barre syndrome. The disorder often begins with a flu-like illness that brings on general physical weakness, but is then characterized by rapidly progressing paralysis that starts in the legs and arms, and may move on (ascend) to affect the breathing muscles and face.

Question 8

How is peripheral neuropathy diagnosed and state four tests used to diagnose it

Answer 8

History taking
•Physical examination
•Blood test
•CT scan
•MRI scan
•Nerve biopsy
•Electromyography: Electromyography (EMG) measures muscle response or electrical activity in response to a nerve's stimulation of the muscle. The test is used to help detect neuromuscular abnormalities.

Question 9

How is peripheral neuropathy reward and managed(pharmacological treatment,procedures done,non pharmacological treatment)

Answer 9

Pharmacological treatment
•Treatment of peripheral neuropathy depends upon the cause. Eg. if diabetes is the cause, then it is important to control blood sugar level.
•Analgesics: Acetaminophen and other NSAIDS like ibuprofen, aspirin
•Other medications: cyclo-oxygenase 2 inhibitor, serotonin or epinephrine reuptake inhibitor etc.

Plasmapheresis can be done in case of polyneuritis also known as plasma exchange
•Works by riding plasma of certain antibodies that contribute to immune system attacks on peripheral nerves.
•Transcutaneous nerve stimulation: goal is to disrupt nerves from transmitting pain signals to the brain.
•Uses low voltage electrical current to relieve pain relief

Non pharmacological:
Casts provide support for the part of the body that is uncomfortable. This can relieve pain.

• Self care;
• Acupuncture
• Massage
• Yoga, exercises etc
• Avoiding alcohol and smoking
• Controlling blood sugar level
• Controlling blood pressure

Question 10

State five ddx for peripheral neuropathy

Answer 10

Carpal tunnel syndrome
•Ulnar neuropathy
•Peroneal nerve entrapment
•Tarsal tunnel syndrome
•Guillain-Barre syndrome
•Multiple sclerosis

Question 11

What is Guilain-Barre syndrome
What does it involve ?
What is a classic description of this disease
Which sex is it more common in

Answer 11

Guilain-Barre Syndrome is a condition in which the immune system attcaks the nerves.

• Involves collection of clinical syndromes that manifests as an acute inflammatory polyradiculoneuropathy with resultant weakness and diminished reflexes.
• Classic description of Guilain-Barre Syndrome is that of a demyelinating neuropathy with ascending weakness.

More slightly common in males

Question 12

State four causes of Guilain-Barre syndrome

Answer 12

The Causes of Guilain-Barre Syndrome include;

• Vaccinations eg. influenza vaccine, COVID vaccine ( Johnson and Johnson vaccine)
• Gastrointestinal and respiratory infections eg. Campylobacter infection ( watery and bloody diarrhea), influenza infection, COVID-19 etc.
• Surgery
• Trauma

Question 13

What is the pathophysiology of Guilain-Barre syndrome

Answer 13

Postinfectious autoimmune reaction that generates cross reactive antibodies ( molecular mimicry)
•Infection triggers humoral response which leads to the formation of autoantibodies against gangliosides (GM1, GD1a) or other unknown antigens of peripheral Schwann cells.
•Immune mediated segmental demyelination will cause axonal degeneration of motor and sensory fibers in peripheral and cranial nerves ( CN III- XII)

Question 14

What are the signs and symptoms of this syndrome when it affects the motor nerve,when there’s cranial nerve involvement,when there’s autonomic dysfunction,what happens to muscle reflexes

Answer 14

When motor nerve is affected:
•lack of coordination
•Ascending weakness and paralysis
•falling
•muscle atrophy

Cranial nerve involvement

• Facial diplegia due to frequent bilateral facial nerve involvement
• Also affects glossopharyngeal nerve (IX) and vagal nerve (X).

•Autonomic dysfunction

• Cardiovascular
• Arrhythmia
• Blood pressure dysregulation
• Voiding dysfunction
• Intestinal dysfunction

Neuropathic pain
- develops in about 2/3 of affected individuals

•Muscle reflexes
- Reduced or absent
-Commonly beginning in the lower limbs
•Paresthesia

Question 15

Name four lab investigations used to diagnose Guilain-Barre Sydrome
And explain

Answer 15

Lumbar puncture/CSF analysis

• Elevated protein levels and a normal white blood cell count in cerebrospinal fluid
• CSF cell counts higher than 50 cells per μL indicates GBS is unlikely

•Electroneurography: Electroneurography is a physiologic test that uses EMG (electromyography) to objectively measure the difference between potentials generated by the facial musculature on both sides of the face in response to a supramaximal electrical stimulation of the facial nerve
- Reduced nerve conduction velocity due to demyelination

Electrocardiogram
- Autonomic cardiac dysregulation

•Serological screening

• To identify potential pathogens eg. Campylobacter jejuni
• Detection of antibodies directed against gangliosides eg. GM1 antibodies

Question 16

State six complications of Guilain-Barre syndrome

Answer 16

Breathing difficulties
•Blood clots
•Relapse
•Bowel and bladder function problems
•Heart and blood problems
•Residual numbness or other sensations

Burns and skin injuries
•Infection: check these areas regularly and treat minor injuries before they become infected, especially if you have diabetes.
•Falls: Weaknesses and loss of sensation may be associated with lack of balance and falling.

Question 17

Name three ways Guilain-Barre syndrome is treated

When do you do plasmapheresis in children

Answer 17

Supportive management:
-Monitor cardiac and respiratory function:
In some cases, intensive care unit treatment and intubation may be indicated
-Turn in bed
-Monitor muscle tone

.Intravenous Immunoglobulins

•Plasmapheresis
In adults: equivalent outcome as IV immunoglobulins
In Children: only in rapidly progressing or severe diseases

Question 18

State four ddx for Guilain-Barre Syndrome

Answer 18

Myasthenia gravis
•Botulism
•Poliomyelitis
•Tick paralysis
•Metabolic neuropathy
•Peripheral neuropathy

Question 19

What is stroke?
Stroke is usually associated with neurological deficit caused by what ?

Stroke is the major neurological disease of our time. Mortality after 1st stroke: 12% by day 56 (UK data; was 21% in 1999). Incidence is falling too (now 1/1000/yr, perhaps due to a more vigorous approach to risk factors in primary care, that is statin use and control of BP)
•Ischemic occlusions contribute to around 85% of casualties in stroke patients, with remainder due to intracerebral bleeding.
True or false

Answer 19

Stroke is a clinical syndrome consisting of rapidly developing clinical signs of focal disturbance of cerebral function lasting more than 4 hours or leading to death with no apparent cause other than a vascular origin ( WHO 1976). OR
Stroke is a sudden death of brain cells due to lack of oxygen caused by blockage of blood flow or rupture of an artery to the brain.

Stroke is typically associated with neurological deficit caused by an acute focal injury of the central nervous system ( brain, spinal cord and retina) by a vascular cause including cerebral infarction, intracerebral haemorrhage and subarachnoid haemorrhage.

True

Question 20

State the six types of stroke

What are the classical features of cerebral ischaemic stroke and intracerebral haemorrhage

Answer 20

Cerebral Ischaemic Stroke
Intracerebral Haemorrhage
Subarachnoid Haemorrhage
Type of Stroke not known 
Transient Ischemic Attack
Cerebrovascular disease with no acute cerebral symptoms 

1.Infarction at single or multiple sites of the brain or retina. Evidence of acute infarction may come from:
•Symptom duration lasting more than 24 hrs
•Neuroimaging or other technique of the brain

2.Haemorrhage within the brain parenchyma or in the ventricular system

Question 21

State the classical features of subarachnoid Haemorrhage,stroke unknown, transient ischemic attack and Cerebrovascular disease with no acute cerebral symptoms

Answer 21

1. Subarachnoid space haemorrhage
2. Lasts more than 24 hours; may lead to death in less than 24 hours; subtype not determined

3.Transient Ischaemic Attack
Transient episode of focal neurological dysfunction caused by focal
brain or retinal ischaemia without acute infarction in the clinically relevant area of the brain or retina; symptoms should resolve completely within 24 hours

4.Cerebrovascular Disease with No Acute Cerebral Symptoms
Silent cerebral infarct that has not caused acute dysfunction of the brain
•Silent cerebral micro-bleed
•Silent cerebral macro-bleed
•Silent white matter abnormalities associated with vascular disease

Question 22

State four causes of Ischemic stroke (AScOD)

State four causes of hemorrhagic stroke(SMASH-U)

Answer 22

ASCOD
•Atherosclerosis
•Small vessel disease
•Cardiac pathology
•Other causes
•Dissection

Structural
•Medication
•Amyloid angiopathy
•Systemic disease
•Hypertension
•unknown

Question 23

State the parts of the brain
The divisions of the cerebrum
What happens in the frontal lobe of a healthy brain or state six normal functions of the frontal lobe and what happens to those functions when same lobe is injured

Answer 23

Brains too
Cerebellum
Cerebrum

Cerebrum:frontal,parietal,temporal,occipital lobes

Frontal:personality or emotions
Intelligence attention or concentration 
Judgement 
Body movement
Problem solving 
Speech(speak and write)

Injured:Mood swings ,irritability and impulsiveness
Change in social behaviour and personality
Unable to focus on a task
Répétition of a single thought
Loss of movement or paralysis
Difficulty with problem solving
Difficulty with language ;can’t get the words out (aphasia )

Question 24

Which lobe controls sense of touch,pain and temperature,
Helps to distinguish size and shape and colour,
Helps w spatial perception (The most prominent characteristic of this cognitive ability is that it allows us the ability to perceive our surroundings with shapes, sizes, distances, etc. Thanks to spatial perception, we can mentally reproduce objects in both 2D and 3D, and anticipate the changes in space. For example, when we walk, dress ourselves, or even draw. Poor spatial perception affects how we focus and understand our body’s relationship to the environment. Another example would be that our spatial perception constantly works to prevent us from walking into walls, chairs, doors, etc. )and visual perception (Visual perception is the brain’s ability to receive, interpret, and act upon visual stimuli. … The ability to remember a specific form when removed from your visual field. 3. Visual-spatial relationships. The ability to recognize forms that are the same but may be in a different spatial orientation.)
What happens to the lobe when it’s Injured

Answer 24

Parietal lobe(p in pain and t in temperature)

Difficulty distinguishing left from right
Lack of awareness or neglect of certain body parts
Difficulties with eye-hand coordination
Problems with reading,writing and naming
Difficulty with mathematics

Question 25

What is the function of the occipital lobe? What happens when it’s injured What’s the function of the cerebellum? What’s happens when it’s injured

Answer 25

Vision Defects in vision or blind spots Blurred vision Visual illusions or hallucinations Difficulty reading and writing Balance and coordination ``` Difficulty coordinating fine movement(Gross motor skills pertain to skills involving large muscle movements, such as independent sitting, crawling, walking, or running. Fine motor skills involve use of smaller muscles, such as grasping, object manipulation, or drawing.) Difficulty walking Tremors Dizziness(vertigo) Slurred speech ```

Question 26

What are the normal functions of this lobe What happens when the temporal lobe is damaged What are the functions of the brainstem What happens when it’s damaged

Answer 26

``` Speech(understanding language) Memory Hearing Sequencing Organization ``` Difficulty understanding language and speaking(aphasia) Difficulty recognizing faces Problems with short and long term memory Difficulty identifying and naming objects Changes in sexual behaviour Increased aggressive behavior Breathing Heart rate Alertness Consciousness Changes in breathing Difficulty swallowing food and water Problems with balance and movement Dizziness and nausea )vertigo)

Question 27

In cerebral circulation,which arteries join to form the Basilar artery Which arteries and carotids form the circle of Willis The circle of Willis is origin of what? If a substance is Injected into the carotid artery where is it distributed to ? Why is there usually no crossing over? What are the branches of internal carotid and the basilar artery

Answer 27

The vertebral arteries unite to form the Basilar artery •The basilar artery and the carotids form the circle of Willis •The circle of Willis is origin of six large vessels supplying the cerebral cortex •If a substance is injected into one carotid artery, it is distributed almost completely to the cerebral hemisphere on that side. Normaly no crossing over occurs probably because the pressure is equal on both sides •The anterior and middle cerebral arteries are branches of internal carotid and the posterior cerebral are branches of basilar artery

Question 28

What is the pathophysiology of ischaemic stroke

Answer 28

The common pathway of ishemic stroke is lack of sufficient blood flow to perfuse cerebral tissue, due to narrowed or blocked arteries leading to inadequate blood supply and thus lack of oxygen. After seconds to minute of cerebral ischemia, the ischemic cascade is initiated. •Important steps of the ischaemic cascade ●Without adequate blood supply and thus lack of oxygen, brain cells lose their ability to produce energy - particularly adenosine triphosphate (ATP). Cells in the affected area switch to anaerobic metabolism, which leads to a lesser production of ATP but releases a by-product called lactic acid. •Lactic acid is an irritant, which has the potential to destroy cells by disruption of the normal acid-base balance in the brain. •ATP-reliant ion transport pumps fail, causing the cell membrane to become depolarized; leading to a large influx of ions, including calcium (Ca++), and an efflux of potassium. Intracellular calcium levels become too high and trigger the release of the excitatory amino acid neurotransmitter glutamate. •Glutamate stimulates AMPA receptors and Ca++-permeable NMDA receptors, which leads to even more calcium influx into cells. Excess calcium entry overexcites cells and activates proteases (enzymes which digest cell proteins), lipases (enzymes which digest cell membranes) and free radicals formed as a result of the ischaemic cascade in a process called excitotoxicity. •As the cell's membrane is broken down by phospholipases, it becomes more permeable, and more ions and harmful chemicals enter the cell. Mitochondria break down, releasing toxins and apoptotic factors into the cell. •Cells experience apoptosis. •If the cell dies through necrosis, it releases glutamate and toxic chemicals into the environment around it. Toxins poison nearby neurons, and glutamate can overexcite them. •The loss of vascular structural integrity results in a breakdown of the protective blood brain barrier and contributes to cerebral oedema, which can cause secondary progression of the brain injury.

Question 29

Based on the causes of ischaemic stroke state the five sub classification of this stroke and state three causes of each

Answer 29

Based on the aetiology of ischaemic stroke, a more accurate sub-classification is generally used: When there’s an occlusion in these arteries it causes it •Large artery disease – atherosclerosis of large vessels, including the internal carotid artery, vertebral artery, basilar artery, and other major branches of the Circle of Willis. •Small vessel disease – changes due to chronic disease, such as diabetes, hypertension, hyperlipidaemia, and smoking, that lead decreased compliance of the arterial walls and/or narrowing and occlusion of the lumen of smaller vessels. The first two can fall under thrombotic stroke Embolic stroke – the most common cause of an embolic stroke is atrial fibrillation. •Stroke of determined aetiology – such as inherited diseases, metabolic disorders, and coagulopathies. •Stroke of undetermined aetiology – after exclusion of all of the above. So the main two types of ischaemic stroke are embolic and thrombotic stroke

Question 30

What is the pathophysiology of hemorrhagic stroke (explain what chases hemorrhagic stroke ,subarachnoid Haemorrhage,intracerebral hemorrhage

Answer 30

Haemorrhagic strokes are due to the rupture of a blood vessels leading to compression of brain tissue from an expanding haematoma. This can distort and injure tissue. In addition, the pressure may lead to a loss of blood supply to affected tissue with resulting infarction, and the blood released by brain haemorrhage appears to have direct toxic effects on brain tissue and vasculature. •Subarachnoid haemorrhage is the gradual collection of blood in the subarachnoid space of the brain dura, typically caused by trauma to the head or rupture of a cerebral aneurysm. Intracerebral haemorrhage – caused by rupture of a blood vessel and accumulation of blood within the brain. This is commonly the result of blood vessel damage from chronic hypertension, vascular malformations, or the use medications associated with increased bleeding rates, such as anticoagulants, thrombolytics, and antiplatelet agents

Question 31

What are the risk factors of stroke(modifiable and non modifiable risk factors)

Answer 31

``` Modifiable: Hypertension Dyslipidaemia Regular meat consumption (no medical reason. Just that research shows it does) Elevated waist to hip ratio: Your waist-to-hip ratio compares your waist measurement to your hip measurement. Higher ratios can mean you have more fat around your waist. This can lead to a higher risk for heart disease(coronary artery disease )or diabetes Diabetes Mellitus Low intake of green leafy vegetables Psychological stress Added salt at the table Cardiac diseases Physical inactivity Current use of cigarettes ``` ``` Non modifiable: Age Sex Ethnicity Family history ```

Question 32

State five symptoms of stroke (stroke affects the brain so to help you remember,find out what happens when those parts of the brain get injured and you’ll get your symptoms)

Answer 32

``` Weakness of the limbs usually one sided •Inability to rise from a sitting or lying position •Slurred speech, inability to talk or understand speech/ loss of speech •Facial drop on one side •Difficulty swallowing •Confusion •Loss of consciousness •Loss of sensation ``` ``` Severe headaches that are usually unlike headaches in the past •Loss of balance or coordination •Vision changes in one eye or both •Dizziness •Seizures •Bladder and bowel incontinence •Nausea and vomiting •Behavioural changes ```

Question 33

State five signs of stroke What is babinski sign If babinski sign is the abnormal response then what is the normal response

Answer 33

Hemiplegia or hemiparesis: Muscle weakness or partial paralysis on one side of the body that can affect the arms, legs and facial muscles. •Dysarthria or slurred speech:Weakness in the muscles used for speech, which often causes slowed or slurred speech. •Aphasia/dysphasia: language disorder marked by deficiency in the generation of speech, and sometimes also in its comprehension, due to brain disease or damage •Reduced level of consciousness •Cranial nerve palsies commonly facial palsy •Nystagmus •Quadriparesis in brain stem strokes: Quadriparesis is a condition in which you have muscle weakness in all four of your limbs (both legs and both arms). Also called tetraparesis, this weakness and diminished mobility can be temporary or permanent.1 •Unilateral loss of sensation •Extensor plantar response or babinski sign : Plantar reflex Diagnostic sign Description Definition: A reflex characterized by upward movement of the great toe and an outward movement of the rest of the toes, when the sole of the foot is stroked. It is a normal reflex up to the age of two. Its presence beyond that age indicates neurological damage This normal response is termed the flexor plantar reflex. In some patients, stroking the sole produces extension (dorsiflexion) of the big toe, often with extension and abduction ("fanning") of the other toes. This abnormal response is termed the extensor plantar reflex, or Babinski reflex

Question 34

``` What is ipsilateral State five ddx of stroke A hypoglycemic person can present as though he or she has stroke true or false Men get stroke more than females True or false ```

Answer 34

Ipsilateral means using the same side arm and leg. For instance, this would me like a boxer throwing a punch with their right hand and driving off their right foot ``` The differential diagnosis of stroke include: •Brain tumour •Subdural haemorrhage •Central nervous system abscess •Electrolyte disturbances •Head injury •Hypo/hyperglycaemia •Epilepsy (Todd’s palsy): Todd's paralysis is a neurological condition experienced by individuals with epilepsy, in which a seizure is followed by a brief period of temporary paralysis. The paralysis may be partial or complete but usually occurs on just one side of the body.2 ```

Question 35

State six tests used to check for stroke and why we’ll do those tests

Answer 35

Blood test- complete blood count checks for levels of platelets. •Angiogram of head and neck- to find blockage or aneurysm of blood vessels •Lipid profile test - to check cholesterol levels •Head CT scan- to show bleeding in the brain and ischemic stroke MRI- to detect brain tissues damaged by an ischemic stroke and brain hemorrhages •Echocardiogram- to find the source of clots in the heart that may have traveled from the heart to the brain and caused a stroke •Cerebral angiography- to produce pictures of major blood vessels in the brain

Question 36

What Are the pharmacological treatment of stroke

Answer 36

* Physiotherapy * Speech therapy * Healthy diet * Regular physical activity * Smoking abstinence * Moderate drinking of alcohol.

Question 37

State five drugs used to manage stroke and why you’d give em

Answer 37

Tissue plasminogen activator - to treat blood clot •Anticoagulant- to treat blood clot •Statin- to decrease the liver’s production of harmful cholestrol •Antihypertensive drugs- to lower blood pressure ACE inhibitors- relaxes blood vessels, lowers blood pressure and prevents diabetes related kidney damage •Aspirin- is a blood thinner. Only give aspirin if ischemic stroke has been confirmed.

Question 38

What are the complications of stroke(early and late complications) State five each

Answer 38

Early ``` EARLY COMPLICATIONS •Malignant cerebral oedema •Haemorrhagic transformation of ischemic brain tissue •Infection -aspiration pneumonia/lobar pneumonia - urinary tract infection (UTI) ``` ``` Dysphagia •Venous thrombo-embolism •Bedsores •Seizures •Shoulder pain (paralyzed or weak arm hanging and pulling on the shoulder) ``` Late ``` LATE COMPLICATIONS •Seizures/epilepsy •Depression •Sleep-disordered breathing •Falls and injuries •Limb contractures ```

Question 39

What is haemorrhagic transformation and how does it occur Significant hemorrhagic transformation of a cerebral infarct usually manifests in a rapid and often profound deterioration in clinical state True or false How is it treated

Answer 39

Hemorrhagic transformation (HT) is a common complication in patients with acute ischemic stroke. It occurs when peripheral blood extravasates across a disrupted blood brain barrier (BBB) into the brain following ischemic stroke. Preventing HT is important as it worsens stroke outcome and increases mortality. Proposed mechanisms for hemorrhagic transformation include reperfusion of ischemically injured tissue, either from recanalization of an occluded vessel or from collateral blood supply to the ischemic territory or disruption of the blood brain barrier. With disruption of the blood-brain barrier, red blood cells extravasate from the weakened capillary bed, producing petechial hemorrhage or more frank intraparenchymal hematoma. Hemorrhagic conversion occurs when blood vessels in the brain rupture after blood flow is restored to the brain after a stroke. HC can cause stroke-like symptoms, as well as complications that can have lasting effects, including disability and death. Hemorrhagic transformation of an ischemic infarct occurs within 2-14 days post ictus(postictal state is a period that begins when a seizure subsides and ends when the patient returns to baseline. It typically lasts between 5 and 30 minutes and is characterized by disorienting symptoms such as confusion, drowsiness, hypertension, headache, nausea, ) usually within the first week. The treatment of hemorrhagic conversion is complex and includes blood pressure management, reversing coagulopathy, and managing its complications including increased intracranial pressure.

Question 40

Hemorrhagic transformation is also more likely following administration of tPA (tissue plasminogen activator)and with noncontrast CT demonstrating areas of hypodensity True or false

Answer 40

True