Stroke

Question 1

What are the two types of stroke and how do they differ?

Answer 1

ischaemic stroke - inadequate blood supply to brain due to infarction of brain tissue
intracranial haemorrhage - tissue death and bleeding in and around brain

Question 2

What mechanisms can disrupt blood supply to the brain?

Answer 2

thrombus
atherosclerosis
shock
vasculitis

Question 3

Describe a TIA.

Answer 3

temporary neurological dysfunction
<24 hrs
caused by ischaemia but without infarction
rapid onset
may precede a stroke

Question 4

What is the name given to 2 or more TIAs within a week and indicate high risk of a stroke?

Answer 4

crescendo TIAs

Question 5

How do strokes typically present?

Answer 5

sudden onset of symptoms suggests a vascular cause
typically asymmetrical
- limb weakness
- facial weakness
- dysphasia (speech disturbance)
- visual field defects
- sensory loss
- ataxia and vertigo (posterior circulation infarction)

Question 6

What are the risk factors of a stroke?

Answer 6

previous stroke or TIA
AF
carotid artery stenosis
hypertension
diabetes
raised cholesterol
family history
smoking
obesity
vasculitis
thrombophilia
combined contraceptive pill

Question 7

Patients on the combined contraceptive pill have a higher risk of stroke if they also have what symptoms?

Answer 7

migraine with aura
smokers >34 years
history of stroke

Question 8

How is a TIA managed?

Answer 8

aspirin 300mg daily
refer for specialist assessment
diffusion weighted MRI

Question 9

How is a stroke managed?

Answer 9

1. exclude hypoglycaemia
2. immediate CT to exclude haemorrhage -> once excluded give alteplase
3. aspirin 200mg daily for 2 weeks
4. admission to specialist stroke centre

Question 10

How can you determine whether a stroke has affected the middle cerebral artery or anterior cerebral artery from the presentation?

Answer 10

middle = one side of body
anterior = leg numbness

Question 11

In what type of stroke should you treat blood pressure?

Answer 11

haemorrhage

Question 12

How do you assess for the underlying cause of a stroke?

Answer 12

carotid artery imaging
ECG

Question 13

What treatments are used in the secondary prevention of a stroke?

Answer 13

clopidogrel 75mg once daily
atorvastatin 20-80mg
blood pressure and diabetes control
rehab

Question 14

After a stroke, how does the treatment differ depending on whether an ECG shows sinus rhythm or AF?

Answer 14

sinus rhythm - treat with antiplatelet
AF - treat with anticoagulation