stroke

Question 1

what is the definition of stroke?

Answer 1

• acute onset of focal neurological symptoms and signs due to disruption of blood supply

Question 2

what are the two types of stroke?

Answer 2

• haemorrhagic

- ischaemic

Question 3

what is an haemorrhagic stroke?

Answer 3

• raised blood pressure
• weakened blood vessel wall due to:
• structural abnormalities like aneurysm, arteriovenous malformation (AVM)
• inflammation of vessel wall (vasculitis)

Question 4

what is an ischameic stroke?

Answer 4

• thrombotic = clot clocking artery at the site of occlusion
• embolic = clot blocking artery has travelled to artery it occludes from somewhere more proximal in the arteries or the heart
• hypoperfusion - due to reduced flow of blood due to stenosed artery rather than occlusion of artery

Question 5

what are the non-modifiable risk factors for stroke?

Answer 5

• age
• family history of stroke
• gender
• race
• previous stroke

Question 6

what are the potentially modifiable risk factors for stroke?

Answer 6

• hypertension
• hyperlipidaemia
• smoking
• prior history of TIA
• AF
• diabetes
• congestive heart failure
• alcohol excess
• obesity
• physical inactivity
• poo socioeconomic status

Question 7

how does smoking affect your risk of stroke?

Answer 7

• doubles your risk

Question 8

what are some rare causes of stroke, especially in younger patients?

Answer 8

• homocysteinemia

- vasculitis

Question 9

how is stroke managed?

Answer 9

• trombolysis or thrombectomy

- identify what caused stroke and start appropriate treatment

Question 10

what are stroke mimics?

Answer 10

• conditions that present acutely with focal neurological signs but are not due to interrupted blood flow
• eg hypoglycaemia, migraine, seizure-postical states
• functional hemiparesis - patient pretending to have a stroke

Question 11

how do you work out what kind of stroke it is?

Answer 11

• brain scan

Question 12

how to work out if it is thrombitic or embolitic?

Answer 12

• blood tests eg glucose, lipids, thrombophillia screen in young patients
• assess for hypertension

Question 13

what is artheroembolism?

Answer 13

• embolism from a thrombus forming on an atheroscelotic plaque - plaque rich clots
• infarcts in same side as affected carotid artery

Question 14

what is cardioembolism?

Answer 14

• embolism from a clot formed in the hear (usually left atrium) - clotting factor rich clots
• infarcts in more than one arterial territory, bilateral

Question 15

if atheroembolism is suspected, what do i do?

Answer 15

• cartotid screening

- CT/MR angiography of aortic arch

Question 16

if cardioembolism is suspected, what do i do?

Answer 16

• ECG
• LVH
• echocardiogram

Question 17

how do you investigate the cause of bleeding in a haemorrhagic stroke?

Answer 17

• hypertensive = usually deep in the brain, older patients

- if young, not hypertensive and lobar haemorrhage - investigate for underlying aneurysm

Question 18

what can be done to reverse disability in an ischaemic stroke?

Answer 18

• thrombolysis =upto 4-5 hours from onset of symptoms
• thrombectomy = up to 6 hours from symptom onset, usually after having started thrombolysis

both are time dependent treatments as brain tissue dies rapidly with any delay

Question 19

how do you prevent the next stroke if atheroembolic or due to thrombosis?

Answer 19

• antihypertensies
• antiplatelets
• statins
• diabetes management
• hypertension management
• lifestyle advice

Question 20

how do you prevent the next stroke if due to AF?

Answer 20

• warfarin
• oral anticoagulants
• antihypertensives

Question 21

what are the surgical managements of stroke?

Answer 21

• haematoma evacuation
• relief of rained intracranial pressure
• carotid endarterectomy

Question 22

what are TIAs?

Answer 22

• temporary neurological symptoms due to occlusion of artery stopping flow of blood
• ## temporary because arteries are capable of dissolving small clots