stroke

Question 1

define stroke

Answer 1

loss of blood flow to part of brain, which damages brain tissue
caused by blood clots and broken blood vessels in brain

Question 2

types

Answer 2

ischaemic - 87%

haemorrhagic - 13%

Question 3

risk factors

Answer 3

hypertension
smoking
age
FH
cardiac causes 
diabetes
stress/depression
cholesterol
bleeding disorders

Question 4

acute treatments

Answer 4

thrombolysis : alteplase - within 4.5hrs of symptom onset
aspirin ASAP within 24hrs of onset

PPI considered in patients with dyspepsia history

Question 5

primary prevention

Answer 5

lifestyle mods 
measures to control BP - lower 
cholesterol levels
diabetes
atrial fibrillation (AF)

Question 6

secondary prevention

Answer 6

use of platelet antiaggregants
antihypertensives
statins
lifestyle mods

Question 7

investigations

Answer 7

imaging = brain CT & MRI
bloods = FBC & CRP, electrolytes, cholesterol, blood clotting, thyroid, blood glucose, heart attack
bedside = BP, pulse oximetry, swallow tests, echocardiogram

Question 8

ischaemic stroke

Answer 8

occur when blood supply to area of brain is reduced - resulting in tissue hypoperfusion

Question 9

haemorrhagic stroke

Answer 9

occur secondary to rupture of blood vessel or abnormal vascular structure within brain

Question 10

transient ischaemic attack (TIA)

Answer 10

symptoms fully resolve within 24hrs (typically within 30mins)

Question 11

clot retrieval

Answer 11

aims to restore normal blood flow
device such as ‘stent retriever’ passes into blocked artery in brain through artery in neck - traps clot so can be removed from artery

X-ray guidance

Question 12

chronic treatment of ischaemic stroke

Answer 12

antiplatelets (clopidogrel)
statins (atorvastatin initiated 48hrs after symptom onset)
BP management
anticoagulation - apixaban, rivaroxaban

Question 13

mechanisms/aetiology of ischaemic stroke

Answer 13

embolism - embolus originating somewhere else in body causes obstruction of cerebral vessel -> hypoperfusion in area of brain the vessel supplies

thrombosis - blood clot forms locally within a cerebral vessel (eg due to atherosclerotic plaque rupture)

systemic hypoperfusion - blood supply to entire brain is reduced secondary to systemic hypotension (eg cardiac arrest)

cerebral venous sinus thrombosis - blood clots form in veins that drain the brain -> venous congestion and tissue hypoxia

Question 14

sub-types of haemorrhagic stroke

Answer 14

intracerebral haemorrhage

subarachnoid haemorrhage

Question 15

intracerebral haemorrhage

Answer 15

involves bleeding within brain secondary to ruptured blood vessel
can be intraparenchymal (within brain tissue) and/or intraventricular (within ventricles)

Question 16

subarachnoid haemorrhage

Answer 16

type of stroke caused by bleeding outside of brain tissue, between pia and arachnoid mater

Question 17

key TIA/stroke symptoms

Answer 17

weakness
sensory disturbance
visual disturbance
speech disturbance
ataxia
dysphagia 
reduced level of consciousness
pain

Question 18

symptoms

Answer 18

F - face
A - arms
S - speech
T - time !!!!!!!