Stroke

Question 1

what is the incidence of stroke in the uk?

Answer 1

110,000 per year
costs 7 billion£

Question 2

outline what a stroke is symptomatically

Answer 2

sudden onset over minutes with progression:
- weakness, speech problems, swallowing problems, visual problems

Question 3

why is stroke important to prevent

Answer 3

1 out of 6 people die in hospital
1/3 of survivors need help for activities of daily living

Question 4

what is the mechanism of a stroke

Answer 4

problem with blood supply to the brain / cerebral circulation

Question 5

what are the two types of stroke

Answer 5

ischaemic
haemorrhagic

Question 6

what is an ischaemic stroke

Answer 6

a ‘blockage’
85% of strokes are ischaemic
atheroma + thrombus on top
embolism

Question 7

what does ischaemia mean

Answer 7

lack of blood supply, in this case due to blockage of vessel

Question 8

what is a haemorrhagic stroke

Answer 8

a ‘bleed’
15 % of strokes are haemorrhagic
atheroma casues rupture
less often aneurysm

Question 9

how does a CT scan show a bleed in the brain

Answer 9

bright white blob

Question 10

what are the causes of arterial disease?

Answer 10

age
hypertension
diabetes (obesity)
hyperlipidaemia (obesity)
smoking
blood clots can also come from the heart and cause ischaemic stroke (cardioembolism)

Question 11

if a man had a stroke and cannot move right side of the body which side is the stroke likely to be on?

Answer 11

left side

Question 12

what is anterior and posterior circulation?

Answer 12

posterior is vertebrobasilar affecting the cerebellum (coordination), occipital lobe (vision), parietal lobe (sensation)
anterior is carotid and affects the temporal lobe (langauge) and frontal lobe (movement)

Question 13

which area is likely to be affected by the stroke if the patient can follow instructions and understand the doctor but cannot speak words to make sense?

Answer 13

brocas aphasia
anterior circulation affecting the temporal lobe on the left hand side

Question 14

why do we need to get people affected by stroke to hospital quickly?

Answer 14

confirm it is a stroke
consider emergency treatment
admit patient to stroke unit for specialist care

Question 15

what is the UK FAST

Answer 15

face
arms
speech
time
campaign for the onset signs of stroke

Question 16

what is wrong with the UK FAST campaign

Answer 16

recognises 70% of strokes
wrongly infers all patients will have same symptoms
many other neurological conditions can cause these symptoms

Question 17

what things can be wrongly thought to be a stroke

Answer 17

seizures
syncope
severe migraine

Question 18

can an ischemic stroke be seen on a CT scan early on?

Answer 18

no the CT can look normal and the infarct will develop and be visible later

Question 19

why is intravenous thrombolysis administered to ischaemic stroke patients

Answer 19

unblocks artery to activate bodies own blood clot removal system and restore blood supply/circulation
but only suitable for 15% of stroke patients

Question 20

what does current evidence say about the benefits of intavenous thrombolysis administration?

Answer 20

chance of favourable outcome decreases with time - evidence shows treatment is beneficial up to 4.5 hours after stroke onset

Question 21

why is intravenous thrombolysis sometimes dangerous

Answer 21

3% of patients get bleeding from the treatment in the brain area affected by the stroke

Question 22

what is a more severe stroke with a blocked main artery called

Answer 22

large vessel occlusion

Question 23

what is a thromborectomy

Answer 23

surgical operation
guide wire is inserted into wrist and fed up to the brain to cerebral arteries and grabs thrombus (blood clot) to remove it

Question 24

when should a thromborectomy be performed?

Answer 24

<6 hours since stroke started
it is complex

Question 25

what % of stroke patients are suitable to a thromborectomy

Answer 25

only 10%
and they are only available in regional neuroscience units

Question 26

what is an CT angiogram

Answer 26

dye injection to visualise blood circulation

Question 27

what is usually visualised on CT angiogram

Answer 27

circle of willis

Question 28

how has AI helped with strokes?

Answer 28

AI assistance for thromborectomy
helps identify large vessel occlusion on a CT angiogram
guides to find where the clot is
this information helps decide most beneficial treatment
evaluates perfusion images

Question 29

what is a haematoma

Answer 29

blood located outside of blood vessles

Question 30

what can be used in treatment of haemorrhagic stroke

Answer 30

intravenous blood pressure lowering drugs to reduce haematoma expansion
‘pro-clotting’ injection (TRANEXAMIC ACID) may have a role in the future

Question 31

so in summary what are the 3 main treatments that should be considered for a stroke patient

Answer 31

for ischaemic stroke - intravenous thrombolysis
for ischameic stroke due to LVO - mechanical thromborectomy
haemorrhagic stroke - control blood pressure

Question 32

what are some blood biomarkers helpful in the identification of stroke type

Answer 32

haemorrhage = HIGH glial fibrillary acidic protein (GFAP)
LVO = HIGH D-dimer (blood clots) or LOW glial fibrillary acidic protein (GFAP)

Question 33

what is the RADAR study

Answer 33

rapid assay diagnostic for acute stroke recognition

Question 34

outline the RADAR study

Answer 34

cohort study to determinate diagnostic accuracy of new portable test to support identification of LVO and haemorrhage
1. LVOne finger prick test - 2 lateral flow assays read in 12 minutes for D-dimer and GFAP.
results for this study are yet to come out