Stroke

Question 1

causes of stroke

Answer 1

• embolus

- reduction in flow

Question 2

presentation

Answer 2

contralateral motor/ sensory deficit
speech related deficit
ipsilateral eyesight (amaurosis fugax)

Question 3

diagnosis

Answer 3

duplex USS
CT
MRI

Question 4

management

Answer 4

stop smoking, reduce lipids, treat hypertension, control diabetes
antiplatelets
carotid endarterectomy

Question 5

define stroke

Answer 5

acute loss of focal cerebral function with vascular causation

Question 6

define significant stenosis

Answer 6

> 50% stenosis of ICA

Question 7

what if you can’t see an endpoint in stenosis of carotids?

Answer 7

carotid surgery will have no benefit

Question 8

when is the most significant risk of a further event in carotid artery disease?

Answer 8

within the first month

Question 9

timing of carotid endarterectomy for females

Answer 9

offered within 2 weeks, after 4 weeks it is of little benefit

Question 10

timing of carotid endarterectomy for males

Answer 10

offered within 2 weeks with benefits still up to 12 weeks

Question 11

describe the carotid endarterectomy

Answer 11

performed under GA or local
arteries above and below are clamped
prior patient should be anticoagulated with IV heparin

Question 12

why is there not brain ischaemia when the carotid artery is clamped?

Answer 12

collaterals for the circle of willis

Question 13

what to do if the collaterals from the circle of willis are not adequate?

Answer 13

inert plastic shunt can be used to divert blood around the clamped artery