stroke

Question 1

definition of stroke?

Answer 1

stroke is a focal neurological deficit due to a vascular lesion.

Question 2

cerebrovascular disease present as?

Answer 2

acute hemorrhage and gradual cerebral ischemia

Question 3

most common incidence of stroke?

Answer 3

cerebral infarction

Question 4

risk factors of stroke?

Answer 4

non modifiable: age, gender(m>f), hereditary, previous vascular event MI and peripheral embolism.
modifiable: HTN, hyperlipidemia, DM heart failure, atrial fibrillation, high alcohol, oral contraceptives, smoking, polycythemia.

Question 5

pathophysiology of stroke?

Answer 5

ischemic: thrombosis, embolism
hemorrhagic: rapture of blood vessels.

Question 6

intracerebral hemorrhage occur at which sites?

Answer 6

cerebellum, pons, internal capsule

Question 7

causes of ischemic stroke?

Answer 7

atherosclerosis, vasculitis(temporal arteritis, polyarteritis nodosa, polycythemia, DIC ,arterial dissection, cocaine and amphetamine.
embolism from cardiac sources mitral stenosis
atheroembolic source, hypercoagulable states form thrombus( deficiency of factor S, C and antithrombin 3

Question 8

causes of hemorrhagic stroke?

Answer 8

HTN, rapture cerebral aneurysm, raptured AV malformation, bleeding disorder, anticoagulant therapy, trauma, amyloid angiopathy(age related) cocaine and amphetamine abuse

Question 9

blood supply of brain?

Answer 9

2 internal carotid
2 vertebral
>internal carotid give: anterior(portions of motor and sensory of leg and bladder, inhibitory micturition center) and middle cerebral arteries( motor and sensory of face hand and arm, broca’s and wernicks area visual cortex and basal ganglia
>vertebrobasilar( brainstem, thalamus, posterial 2/5 of cerebrum.

Question 10

clinical classification of stroke?

Answer 10

TIA: symptoms remains less than 24 hr
evolving stroke: stepwise increase in focal neurological deficit from hours to days
complete stroke: when symptoms persist for more than 24 hr.

Question 11

features of internal carotid TIA?

Answer 11

weakness of contralateral side of body, numbness or paresthesia may also occur as sole representation, aphasia, amaurosis fugax.

Question 12

features of vertebrobasilar TIA?

Answer 12

vertigo, ataxia, diplopia ,dysarthria, dimness, blurring of vision, drop attack due to bilateral leg weakness

Question 13

D/D of TIA?

Answer 13

focal epilepsy(jerking of limbs not in TIA)
migraine( headache and visual disturbance not in TIA)

Question 14

investigations?

Answer 14

Blood cp, FBS. serum cholesterol, ECG, X-ray chest, echo, blood culture, carotid doppler, CT/MRI on urgent basis to differentiate infarction and hemorrhage.

Question 15

treatment?

Answer 15

Medical treatment:
Tissue plasminogen activator if present less than 4.5 hour of symptoms appear then aspirin
embolization from carotids: aspirin 300mg daily or clopidogrel 75mg or dipyridamole 200mg
embolization from heart: anticoagulant heparin followed by warfarin if they not suited then anti-platelet aggregation aspirin 300mg/day
surgical include angioplasty by stent or carotid endarterectomy if 70-99% stenosd

Question 16

treatment for TIA according to NSF?

Answer 16

antiplatelet, anticoagulation, statins, carotid surgery.

Question 17

D/D of evolving stroke?

Answer 17

subdural hematoma, cerebral tumor

Question 18

difference between TIA and stroke?

Answer 18

in TIA symptoms don’t lasting long

Question 19

most common type of stroke?

Answer 19

hemiplegic infarction of internal capsule

Question 20

why middle cerebral artery is more affected by emobolism?

Answer 20

emboli from heart and carotid enter into large caliber middle cerebral artery than anterior cerebral artery secondly colateral from anterior communicating arteries prevent ischemia

Question 21

conciousness is altered in which artery involved?

Answer 21

vertebrobasilar

Question 22

when coma occur in stroke?

Answer 22

when infarction of brainstem involved reticular formation

Question 23

which type of aneurysm raptured in hypertensive patient?

Answer 23

charcot-bouchard aneurysms

Question 24

clinical features of hemorrhagic stroke?

Answer 24

abrupt onset of headache with focal neurological deficit worsen over 30-90 min

Question 25

surgical evacuation of hematoma?

Answer 25

not helpful except in cerebral hematoma

Question 26

medical management of hemorrhagic stroke?

Answer 26

``` Airway protection if gcs<8 Head elevated 30-45 Reverese coagulopathy with vit k and ffp Platelet transfused if expanding ICH mannitol to reduce ICP blood pressure control <160-140 nursing Surgical management: decompression hemicraniectomy ```

Question 27

findings of CSF after several hours of subarachnoid hemorrhage?

Answer 27

yellow color csf xanthochromic

Question 28

What is locked in syndrome?

Answer 28

``` Basilar or vertebral artery occlusion Progressive awake quadriplegia Bilateral facial and oropharyngeal palsy Preserve cortical function and vertical gaze Patient is awake until ras involved ```

Question 29

Pica?walenburg syndrome

Answer 29

Vertigo, comiting, nystagmus, contralateral sensory loss Ipsilateral horner syndrome Dysphagia and dysarthria Ipsilateral ataxia

Question 30

Most common site of hemorrahgic stroke?

Answer 30

Putamen, then thalamus pons and cerebral hemisphere

Question 31

Most common type of SAH?

Answer 31

Saccular berry aneurysm( junction of anterior cerebral artery with anterior communicating artery

Question 32

What if ct scan is negative in SAH?

Answer 32

Lumber puncture xanthochromic csf from rbc breakdown)

Question 33

Difference of Lp of meningitis and SAH?

Answer 33

In meningitis wbc:rbcs ratio increases In SAH: normal Normal: 1wbc per 500-1000 rbcs

Question 34

Treatment of SAH?

Answer 34

CCB nifidipine to prevent vasospam Siezure prophyalix Surgixal clipping Surgical coiling is prefer now