Stroke

Question 1

In simple terms, what is a stroke?

Answer 1

Loss of blood supply/oxygen to a brain region leading to death of neurones.

Question 2

What are the two classifications of stroke?

Answer 2

Ischaemic and haemorrhagic

Question 3

Which is more common, ischaemic or haemorrhagic stroke?

Answer 3

Ischaemic

Question 4

Which typically has a more significant impact/threat to life, ischaemic or haemorrhagic stroke?

Answer 4

Haemorrhagic

Question 5

Haemorrhagic strokes occur for approximately what percentage of stroke events?

Answer 5

20%

Question 6

What percentage of people will die within one month following a stroke?

Answer 6

1 in 5 (20%)

Question 7

What occurs in an ischaemic stroke?

Answer 7

An obstruction blocks blood flow to a part of the brain.

Question 8

What occurs in a haemorrhagic stroke?

Answer 8

Weakened blood vessel ruptures, causing bleeding inside or around brain tissue.

Question 9

Ischaemic stroke obstructions are usually due to either ____ or ____.

Answer 9

Thrombus or embolism.

Question 10

A thrombus is usually associated with ____ ____.

Answer 10

Atherosclerotic plaque

Question 11

TIA’s can be an indicator of underlying ____ ____.

Answer 11

Thrombotic disease.

Note: would also accept ‘cardiovascular disease’.

Question 12

Haemorrhagic strokes are commonly associated with what chronic health condition?

Answer 12

Chronic hypertension

Question 13

Aside from hypertension, what two other conditions are often associated with haemorrhagic stroke?

Answer 13

Aneurism or arterio-venous malformation

Question 14

Why is significantly higher mortality and death associated with haemorrhagic rather than ischaemic stroke?

Answer 14

This type can significantly displace brain tissue and increase intracranial pressure (ICP)

Question 15

Describe the neurotoxic domino effect

Answer 15

Loss of O2 and glucose results in rapid necrosis of the directly affected area and the damage extends beyond this area due to a neurotoxic effect; neighbouring and regional cells undergo apoptosis due to excitotoxicity.

Question 16

Describe excitotoxicity

Answer 16

Dying cells release excessive amounts of glutamate (an NT) which hyperactivates surrounding cells and induces massive influx of calcium which triggers apoptosis (self destruction)

Question 17

Aside from excessive glutamate, what other substance is produced by the excitotoxicity process that further expands the damage zone?

Answer 17

Reactive free radical species

Question 18

What are some common conditions/lifestyle choices that lead to stroke?

Answer 18

• Hypertension
• Diabetes
• Smoking

i.e. leading to atherosclerosis

Question 19

List some general symptoms of stroke

Answer 19

• Confusion
• Speech problems (dysphasia/aphasia)
• Paralysis on opposite side to damaged hemisphere
• Severe headache
• ALOC
• Visual disturbances

Question 20

What is aphasia?

Answer 20

Loss of speech/language abilities

Question 21

Aphasia is caused by damage to either or both of what two areas of the brain?

Answer 21

Broca’s area and Wernicke’s area

Question 22

Describe the presentation of a pt with damage to Broca’s area

Answer 22

Unable to speak but are able to understand speech of others

Question 23

Describe the presentation of a pt with damage to Wernicke’s area

Answer 23

Able to speak but speech is nonsensical, and unable to understand others

Question 24

Describe the difference in function between Broca’s area and Wernicke’s area

Answer 24

Broca’s area: speech

Wernicke’s area: makes sense of speech

Question 25

List six characteristics consistent with Broca's aphasia

Answer 25

* Halting/no speech * Repetition * Disordered grammar * Disordered syntax * Cannot pronouce individual words (mixes letters) * Comprehension intact

Question 26

List five characteristics consistent with Wernicke's aphasia

Answer 26

* Speaks fluently * Words, syntax, grammar correct * Makes no sense to listen to * Uses inappropriate words * Does not comprehend what others say

Question 27

List six things that could mimic a stroke

Answer 27

* Hypoglycaemia * Tumours/lesions * Seizure * Electrolyte imbalance * Migraine * Conversion disorder (psychiatric, pt feels real symptoms)

Question 28

What is the purpose of the GCS?

Answer 28

To determine the extend of a pt's brain dysfunction

Question 29

What is a TIA?

Answer 29

A short (transient) depletion of O2 in a brain area with symptoms that resolve

Question 30

What are the three questions when rx stroke?

Answer 30

1. Ischaemic or haemorrhagic 2. Time of event 3. SPO2 value

Question 31

What symptoms might suggest haemorrhagic stroke?

Answer 31

* N+V * Severe headache * ALOC * Symptoms indicative of increased ICP

Question 32

On non-contrast CT scans, what do white areas indicate?

Answer 32

Blood

Question 33

On non-contrast CT scans, what do dark shadows indicate?

Answer 33

Ischaemia

Question 34

What is the best method for early detection of ischaemic stroke?

Answer 34

Diffusion-weighted MRI (DWI) (measures diffusion of water molecules)

Question 35

Fibrinolysis is given to which kind of stroke, ichaemic or haemorrhagic?

Answer 35

Ischaemic

Question 36

Describe the action of fibrinolysis

Answer 36

* Gives tPA (tissue plasminogen activator) * tPA is an enzyme that facilitates cleavage of active from inactive plasminogen * Active plasminogen becomes plasmin * Plasmin breaks down the fibrin clot