STROKE

Question 1

What is a stroke?

Answer 1

A stroke is a medical condition that occurs when the blood supply to a part of the brain is interrupted or reduced preventing brain tissue from getting oxygen and nutrients.

Question 2

What is a Transient Ischemic Attack (TIA)?

Answer 2

A Transient Ischemic Attack (TIA) is often called a ‘mini-stroke’ and occurs when there is a temporary decrease in blood supply to part of the brain.

Question 3

What is cerebrovascular disease?

Answer 3

Cerebrovascular disease is a condition that affects the blood vessels in the brain leading to strokes and other neurological injuries.

Question 4

What are the two main types of strokes caused by cerebrovascular disease?

Answer 4

The two main types of strokes are ischemic strokes (80%) and hemorrhagic strokes (20%).

Question 5

Why is cerebrovascular disease significant in public health?

Answer 5

Cerebrovascular disease is significant because it is the third leading cause of death in developed countries and a major cause of long-term disability.

Question 6

What are Transient Ischaemic Attacks (TIAs)?

Answer 6

TIAs are transient episodes of neurological dysfunction caused by focal brain spinal cord or retinal ischaemia without acute infarction.

Question 7

What are the common causes of TIAs?

Answer 7

The common causes of TIAs include atherosclerotic thromboembolism and cardioembolism related to the cerebral circulation.

Question 8

Why is the diagnosis and management of TIAs important?

Answer 8

Diagnosis and management of TIAs are important to prevent a potentially devastating stroke.

Question 9

What happens to brain tissue during ischaemic stroke due to oxygen deprivation?

Answer 9

Brain tissue may undergo metabolic changes leading to cell death.

Question 10

What is the ischaemic penumbra?

Answer 10

The ischaemic penumbra is an area of threatened but potentially salvageable brain tissue surrounding an infarct.

Question 11

What are the primary causes of ischaemic strokes?

Answer 11

Ischaemic strokes are primarily caused by thromboembolism from the cerebral vasculature heart or aorta.

Question 12

How does atherosclerosis contribute to ischaemic strokes?

Answer 12

Atherosclerosis leads to thrombus formation at plaque sites which can obstruct blood flow in the brain.

Question 13

What complications can occur following a large anterior circulation ischaemic stroke?

Answer 13

Complications may include increased mass effect intracranial pressure and secondary hemorrhage into the infarct.

Question 14

What are the most common causes of ischaemic strokes and transient ischaemic attacks (TIAs)?

Answer 14

Atherosclerotic thromboembolism of the cerebral vasculature and emboli from the heart.

Question 15

Why is imaging necessary before starting treatment for suspected strokes?

Answer 15

To differentiate between haemorrhagic and ischaemic strokes as they require different treatments.

Question 16

What is the ABCD2 score used for in the context of TIAs?

Answer 16

It is a clinical scoring system used to assess the risk of stroke following a TIA.

Question 17

What is the recommended time frame for administering thrombolytic therapy in acute ischaemic strokes?

Answer 17

Within 4.5 hours of symptom onset.

Question 18

What factors can complicate the differentiation of strokes from other neurological conditions in the emergency department?

Answer 18

Atypical presentations and the overlap of symptoms with other conditions.

Question 19

What is the benefit of admitting stroke patients to a dedicated stroke unit?

Answer 19

Improved outcomes due to a multidisciplinary approach to management.

Question 20

What are the non-modifiable risk factors for ischaemic stroke?

Answer 20

Increasing age gender and family history.

Question 21

What is the most important modifiable risk factor for stroke prevention?

Answer 21

Hypertension.

Question 22

Which cardiac condition is the most significant risk factor for TIA and stroke?

Answer 22

Atrial fibrillation (AF).

Question 23

What are the CHADS2 and CHA2DS2-VASc scores used for?

Answer 23

To standardize the approach to primary stroke prevention in patients with non-valvular AF.

Question 24

What lifestyle factors contribute to increased stroke risk?

Answer 24

Diabetes smoking and hypercholesterolaemia.

Question 25

What is the role of carotid endarterectomy in asymptomatic patients with carotid stenosis?

Answer 25

Its role is controversial; intensive medical therapy is often preferred.

Question 26

What are some common stroke mimics that can lead to misdiagnosis?

Answer 26

Common stroke mimics include seizures hypoglycaemia systemic infection brain tumour and toxic/metabolic disorders.

Question 27

Why is it important to differentiate between stroke and its mimics?

Answer 27

Differentiating between stroke and its mimics is crucial because it affects treatment decisions such as the use of thrombolysis.

Question 28

List at least three conditions that can mimic a stroke.

Answer 28

Three conditions that can mimic a stroke are seizures (with Todd paresis) hypoglycaemia and hypertensive encephalopathy.

Question 29

What role do clinical investigations play in the differential diagnosis of stroke?

Answer 29

Clinical investigations help identify contributing factors to stroke/TIA and guide therapy differentiating it from other conditions.

Question 30

What is Todd paresis and how is it related to stroke mimics?

Answer 30

Todd paresis is a postictal neurological deficit following a seizure which can mimic stroke symptoms.

Question 31

What is the primary imaging modality used in the diagnosis of transient ischemic attacks (TIAs)?

Answer 31

A head CT or MRI scan is indicated for all patients with TIA.

Question 32

Why is MRI preferred over CT for detecting posterior territory ischemic lesions in stroke patients?

Answer 32

MRI is more sensitive than CT in detecting posterior territory ischemic lesions especially in the brain stem.

Question 33

What is the role of CT perfusion studies in acute stroke management?

Answer 33

CT perfusion studies help identify areas of irreversibly infarcted brain and at-risk ischemic brain.

Question 34

What imaging technique is used to evaluate carotid stenosis in TIA patients?

Answer 34

Carotid ultrasound is the traditional first-line study for carotid stenosis.

Question 35

What is the significance of diffusion-weighted imaging (DWI) in acute stroke diagnosis?

Answer 35

DWI is highly sensitive for detecting early ischemia or infarction within an hour of stroke onset.

Question 36

When is a transesophageal echocardiogram (TOE) indicated in the evaluation of TIAs?

Answer 36

TOE is indicated when TTE results are inconclusive and there is ongoing concern for a cardioembolic source.

Question 37

What is the Alberta Stroke Program Early CT Score (ASPECTS) used for?

Answer 37

ASPECTS is used to quantify the degree of acute ischemic change on CT scans in stroke patients.

Question 38

What are the advantages of using CT angiography (CTA) in stroke evaluation?

Answer 38

CTA provides rapid imaging of vessels and can identify large vessel occlusions.

Question 39

What factors determine the treatment strategy for stroke patients?

Answer 39

The treatment strategy is determined by the nature and site of the neurological lesion and its underlying cause.

Question 40

What is the recommended blood pressure management for patients eligible for thrombolytic therapy in ischemic stroke?

Answer 40

Blood pressure should be reduced to less than 185/110 mm Hg prior to treatment and maintained below this level for 24 hours.

Question 41

What is the ABCD2 score used for in the context of transient ischemic attacks (TIAs)?

Answer 41

The ABCD2 score is used for risk stratification to evaluate the early risk of stroke following a TIA.

Question 42

What is the role of antiplatelet therapy in the management of TIAs and minor strokes?

Answer 42

Aspirin should be started at a dose of 300 mg and maintained at 75 to 150 mg/day to prevent further ischemic events.

Question 43

What are the indications for thrombolysis in acute ischemic stroke?

Answer 43

Thrombolysis is indicated for patients with significant neurological deficits and no evidence of hemorrhage on CT treated within 3 to 4.5 hours of symptom onset.

Question 44

What are the potential risks associated with thrombolysis in stroke treatment?

Answer 44

The primary risk is spontaneous intracranial hemorrhage (SICH).

Question 45

What is the significance of clot retrieval in the management of ischemic stroke?

Answer 45

Clot retrieval can improve neurological outcomes in patients with large vessel occlusion up to 6 hours after symptom onset.

Question 46

What is the recommended approach for managing elevated temperature in stroke patients?

Answer 46

Elevated temperature should be controlled and may indicate other underlying issues.

Question 47

What is the role of surgery in the treatment of symptomatic carotid stenosis?

Answer 47

Urgent surgery may be beneficial for symptomatic carotid stenosis of 70% to 99% in patients with TIAs and minor strokes.

Question 48

What is the importance of pre-hospital care in stroke management?

Answer 48

Pre-hospital care focuses on rapid identification and transport to stroke centers for timely treatment.

Question 49

What is one controversy regarding thrombolysis in stroke management?

Answer 49

Thrombolysis beyond 3 hours post-onset is controversial.

Question 50

What role do advances in neuroimaging play in stroke management controversies?

Answer 50

Advances in neuroimaging may improve patient selection for vessel opening strategies.

Question 51

What is a key area of research in interventional therapies for acute ischemic stroke?

Answer 51

Research is focused on prolonging treatment windows and increasing recanalization rates.

Question 52

What is the current status of neuroprotective therapies in stroke management?

Answer 52

Neuroprotective therapies cannot be recommended outside of clinical trials.

Question 53

What is a recent trend in managing patients with Transient Ischemic Attacks (TIA)?

Answer 53

Management is shifting towards an outpatient model of care.

Question 54

What is subarachnoid haemorrhage (SAH)?

Answer 54

SAH is the presence of extravasated blood within the subarachnoid space.

Question 55

What is the primary clinical feature of SAH?

Answer 55

Severe sudden headache.

Question 56

What is the initial investigation of choice for diagnosing SAH?

Answer 56

A computed tomography (CT) scan of the brain without contrast.

Question 57

What should be done if a CT scan for SAH is negative?

Answer 57

Follow up with a lumbar puncture and examination of the cerebrospinal fluid.

Question 58

Why is early diagnosis and treatment of SAH important?

Answer 58

Early occlusion of the aneurysm reduces complications and improves outcomes.

Question 59

What is a common cause of subarachnoid haemorrhage?

Answer 59

Head trauma is the most common cause of SAH.

Question 60

What is a sentinel haemorrhage in the context of SAH?

Answer 60

A warning leak that occurs hours to days prior to the major bleed.

Question 61

What is the risk of re-bleeding after SAH?

Answer 61

The risk of re-bleeding is maximal in the first 2 to 12 hours after the initial bleed.

Question 62

What treatment is typically preferred for SAH?

Answer 62

Endovascular treatment is the treatment of choice in most cases.