stroke

Question 1

what is stroke - textbook?

Answer 1

acute focal neurological deficit lasting for more than 24hrs

Question 2

describe a stroke

Answer 2

death of brain tissue from hypoxia
no local cerebral blood flow caused by infarction of tissue or haemorrhage into brain tissue

Question 3

what does FAST stand for?

Answer 3

facial drooping
arm weakness
speech difficulty
time

Question 4

what does TIA stand for?

Answer 4

transient ischaemic attack

Question 5

what is ischemia?

Answer 5

restriction of blood supply and therefore oxygen to any tissue/part of body

Question 6

what is a transient ischemic attack?

Answer 6

localised loss of brain function
full recovery of brain tissue within 24 hrs (most recover in 30 min)

Question 7

people that have suffered a TIA are at higher risk of what?

Answer 7

proper stroke
myocardial infarction

Question 8

what are risk factors for stroke?

Answer 8

hypertension
smoking
alcohol

diabetes mellitus

Question 9

what is the most common cause of stroke?

Answer 9

infarction 85%
followed by haemorrhage 10%, subarachnoid haemorrhage and venous thrombosis <1%
also vasculitis

Question 10

what are the causes of stroke?

Answer 10

ischemic - cause uncertain
intracranial bleed
embolic stroke
atheroma of cerebral vessels
venous thrombosis

Question 11

what causes an embolic stroke?

Answer 11

embolism from L side of heart
atrial fibrillation, recent MI or heart valve disease

Question 12

what causes inter-cranial bleed/haemorrhage stroke?

Answer 12

aneurysm rupture

Question 13

where might you find an atheroma of cerebral vessels?

Answer 13

carotid bifurcation
internal carotid
vertebral artery

Question 14

give examples of stroke prevention

Answer 14

reduce risk factors - smoking, diabetic control, hypertension control

anti platelet action - aspirin, clopidogrel

anticoagulants if embolic risk - AF, LV thrombosis - warfarin, apixiban

carotid endarectomy, preventative neurosurgery

Question 15

what tests can be used to assess risk factors of stroke?

Answer 15

carotis ultrasound
cardiac ultrasound
ECG
blood pressure
diabetes screen

Question 16

what imaging techniques can investigate stroke?

Answer 16

CT
MRI
MRA - best to visualise brain circulation
DSA - if MRA not available

Question 17

what does CT stand for in imaging?

Answer 17

computerised tomography

Question 18

what does MRI stand for in imaging?

Answer 18

magnetic resonance imaging

Question 19

what does MRA stand for in imaging?

Answer 19

magnetic resonance angiography

Question 20

what does DSA stand for in imaging?

Answer 20

digital subtraction angiography

Question 21

what impact does stroke have on dentistry?

Answer 21

impaired mobility and dexterity - OH and attendance
communication - dysphonia, dysarthria
risk of cardiac emergency - MI
loss of protective reflexes - aspiration
loss of sensory information - dentures
stroke pain

Question 22

how would you assess risk factors of stroke?

Answer 22

carotid ultrasound
cardiac ultrasound - LV thrombosis
ECG to check arrhythmias
blood pressure
diabetes screen
thrombophilia screen - young patients

Question 23

what are the effects of a stroke on brain?

Answer 23

loss of functional brain tissue - immediate nerve cell data or ischaeamia in penumbra around infarction

inflammation in tissue surrounding infarct/bleed

Question 24

what are the complications of a stroke?

Answer 24

motor function loss
dysphonia
swallowing - aspiration of food and saliva leading to pneumonia
sensory loss
cognitive impairment
body perception

Question 25

a stroke affecting cranial or somatic nerve will affect which side of body?

Answer 25

opposite side to lesion

Question 26

cognitive impairment affects what?

Answer 26

appreciation processing understanding speech and language - dysphasia, dyslexia memory impairment emotional

Question 27

how is a stroke managed?

Answer 27

acute phase - limit damage and reduce future risk chronic phase - rehab and reduce future risk

Question 28

what is involved in the acute phase of stroke treatment?

Answer 28

reduce damage - penumbra region survivable ischaemia, Ca channel blockers improve blood flow and oxygenation normoglycaemia as hyper or hypo is harmful remove haematoma in subarachnoid haemorrhage prevent future risk - 300mg aspirin daily

Question 29

what dose of aspirin should be given daily as a prevention of future stroke risk?

Answer 29

300mg daily

Question 30

what indicates anticoagulation medication after a stroke?

Answer 30

AF left ventricular thrombosis (warfarin, apixiban)

Question 31

what is involved in the chronic phase of stroke treatment?

Answer 31

nursing and rehab - immobility support, prevent bed sores and physiotherapy speech and language therapy - communication, eating occupational therapy

Question 32

what are the two types of stroke?

Answer 32

ischaemic stroke haemorragic stroke