Stroke

Question 1

What are the two types of stroke?

Answer 1

Ischaemic and haemmorhagic

Question 2

What are the different types of ischaemic stroke?

Answer 2

Thrombotic

• regular thrombotic
• TIA
• Lacunar

and embolic

Question 3

Describe a haemorrhagic stroke

Answer 3

Artery in brain bleeds out into surrounding tissue

Artery post bleed has little blood flow

= neurons deprived of oxygen

Question 4

Describe a embolic stroke

Answer 4

Embolism blocks artery = neurons deprived of oxygen

Question 5

Describe a thrombotic stroke

Answer 5

Atherosclerosis = blood clot = severely reduced blood flow = neurons deprived of oxygen

Question 6

Description of haemorrhagic stroke

Answer 6

Blood vessel rupture

• direct brain injury
• secondary occlusion to nearby vessels
• lethal in up to 50% at first rupture
• reduces perfusion
• increased intracranial pressure
• later, irritating blood can cause vasospasm resulting in secondary ischaemic injury
• cerebral herniation

Question 7

Haemorrhagic stroke different types

Answer 7

Intracerebral haemorrhagic

Subarachnoid haemorrhagic

Question 8

Intracerebral haemorrhagic stroke definition and causes

Answer 8

ICH bleed occurs within the brain, blood collects and puts pressure on the surrounding tissue

Common causes 
High blood pressure 
Injury 
Bleeding disorders 
Deformities in blood vessels

Question 9

Subarachnoid haemorrhage stroke definition and causes

Answer 9

Blood vessel on surface of brain ruptures,

Blood builds up and puts pressure on subarachnoid space.

Most common symptom of this is thunderclap headache - worst headache ever

Question 10

TIA definition

Answer 10

Transient ischaemic attacks

Less severe than stroke

Temporary interruption of blood flow (thrombotic)

Usually in carotid and vertebrobasiliar arteries

All neurological defects need to be clear within 24hrs

Question 11

Stroke mimics definition

Answer 11

A non vascular disease that presents with stroke like symptoms. Often indistinguishable from actual stroke

Question 12

What are common stroke mimics

Answer 12

Hypoglycaemia
Seizure
Migraine
Infection such as sepsis

Question 13

Fast assessment stroke

Answer 13

Face
- mouth eyes droop?

Arms
- both arms raised same

Speech
- speak clearly, understand instructions

Time
- since onset? Last seen well

Question 14

ABCD2 tool

• predictor of stroke after TIA

Answer 14

Age > 60yrs.  (1pt)
Blood pressure >140/90 (1pt)
Clinical features- 
    unilat weakness (2pt)
    Speech impairment w/out weakness (1pt) 
Duration
     >60min (2pt)
     10-59min (1pt) 
Diabetes (1pt) 

Score >4 =high risk

Question 15

What ABCD2 score is high risk?

Answer 15

> 4

Question 16

What does NIHSS involve

Answer 16

Less points better

LOC /3
- AVPU SCORE

LOC questions /2
- birthday and month

Commands /2

• close/open eyes
• grip hands

Best gaze / 2
- horizontal gaze test

Facial palsy /3
- show teeth, close eyes right, raise eyebrows

Motor arm /4
- raise arms

Dysarthria /2
- read/repeat list of words

Extinction/neglect /3

• touch arms with eyes closed
• show fingers in both visual fields

Question 17

Thrombolytics

Answer 17

tPA must be started within 4.5 hours of stroke post CT scan