Stroke

Question 1

What are the different types of haemorrhagic stroke?

Answer 1

Structural abnormality
Hypertensive
Amyloid angiopathy

Question 2

What are the different types of infarct stroke?

Answer 2

Cardioembolic
Small vessel
Atheroembolic

Question 3

What are the features of a POCI?

Answer 3

CN deficit with contralateral hemiparesis or sensory deficit
OR 
Bilateral stroke
OR
Disorders of conjugate eye movement
OR
Isolated cerebellar stroke
OR
Isolated homonymous hemianopia

Question 4

What are the features of a TACI?

Answer 4

NEED ALL 3:
New higher cerebral function dysfunction: dysphasia, dyscalculia, apraxia, neglect, visuospatial problems
Homonymous visual field defect
Ipsilateral motor and/ or sensory deficit of at least two areas of face, arm and leg

Question 5

What are the features of a PACI?

Answer 5

Two of 3 components of TACI
OR
Isolated dysphasia or other cortical dysfunction
OR motor/ sensory loss more limited than for a LACI

Question 6

What are the features of a LACI?

Answer 6

Pure motor OR pure sensory deficit affecting two of face, arm and leg
Sensorimotor stroke (basal ganglia and internal capsule)
Ataxic hemiparesis (cerebellar type ataxia with ipsilateral pyramidal signs; internal capsule or pons)
OR
Dysarthria plus clumsy hand
OR
Acute onset movement disorders (hemichorea, hemiballismus; basal ganglia)

Question 7

Which stroke has the worst outcomes?

Answer 7

TACI; total anterior circulation infarction

Question 8

What are lacunar strokes associated with?

Answer 8

Hypertx
Diabetes
Smoking etc

Question 9

What does the left side of the brain control?

Answer 9

Motor and sensory of right side
Language centers
Reasoning 
Written language
Number skills

Question 10

What does the right hemisphere control?

Answer 10

Motor and sensory of left body
Creativity
Music
Artistic awareness
Spatial awareness; neglect syndrome

Question 11

What is the 1st line investigation in carotid disease?

Answer 11

USS for narrowing

Question 12

What should be done if narrowing of the carotid vessels is seen on USS?

Answer 12

CTA or MRA

Question 13

What is the threshold of narrowing for referral for carotid endarterectomy?

Answer 13

50-99%

Question 14

What is type 1 small vessel disease?

Answer 14

Arteriosclerotic; 
Fibrinoid necrosis
Liophylaniosis
Microatheroma
Microaneurysm

Question 15

What is type 2 small vessel disease?

Answer 15

Sporadic and hereditary cerebral amyloid angiopathy

Question 16

What is type 3 small vessel disease?

Answer 16

Genetic small vessel disease; CADASIL

Question 17

What is type 4 small vessel disease?

Answer 17

Inflammatory and immunologically mediated:

eGPA, GPA

Question 18

What is type 5 small vessel disease?

Answer 18

Venous collagenosis

Question 19

What is type 6 small vessel disease?

Answer 19

Post radiation angiopathy

Question 20

What are the MRI expressions of small vessel disease?

Answer 20

White matter hyperintensities
Microbleeds
Leukoaraiosis

Question 21

What conditions result in cardioembolic strokes?

Answer 21

AF; 50% 
Acute MI
Prosthetic valves
Ventricular thrombus
Rheumatic heart disease

Question 22

Why can PFO result in a stroke?

Answer 22

Due to patent foramen ovale; venous clots can pass from the venous to arterial side and travel up to the brain

Question 23

What is the treatment for PFO?

Answer 23

If it causes a stroke in a younger patient; surgical closure and clopidogrel

Question 24

Why can arterial dissection result in a stroke?

Answer 24

Exposure of underlying collagen

Clot formation

Question 25

What is the treatment for arterial dissection?

Answer 25

Treat like normal stroke Give antiplatelets OR anticoags Recan after 6 months to see if abnormality persists; if it does then continue antiplatelets, if it has completely healed with no structural abnormalities then antiplatelets can be stopped

Question 26

What can cause a primary intracerebral haemorrhage?

Answer 26

Hypertx | Amyloid angiopathy

Question 27

What can cause a secondary intracerebral haemorrhage?

Answer 27

AVM Aneurysm Tumour

Question 28

What does a peripheral and lobar haemorrhage suggest?

Answer 28

Amyloid angiopathy

Question 29

What does a deep, central haemorrhage suggest?

Answer 29

Hypertensive in nature

Question 30

What is early haematoma expansion?

Answer 30

Continued arterial bleeding Secondary bleeding into perilesional tissue Subsequent perilesional oedema

Question 31

What is a good example of a description of a stroke?

Answer 31

Type, size, laterality and cause E.g. Right hemispheric, cardioembolic, partial anterior circulation infarction

Question 32

What is the ABCD of medical stroke prevention?

Answer 32

``` Antithrombotic therapy Blood pressure control Cholesterol control Diabetes assessment Don't smoke ```

Question 33

When will antiplatelets and anticoags be used?

Answer 33

Antiplatelets; atherosclerotic or small vessel disease | Anticoag: cardioembolic

Question 34

Which scoring system is used to assess clot risk for patients with AF?

Answer 34

CHA2DS2 VASc score

Question 35

What score on CHA2DS2 VASc indicates that anticoagulation should be give?

Answer 35

2 or more

Question 36

Which scoring system is used to assess bleeding risk on blood thinners?

Answer 36

HAS-BLED

Question 37

What statin should be given to reduce stroke risk?

Answer 37

High dose atorvastatin; 80mg

Question 38

Should a statin be given post-haemorrhagic stroke?

Answer 38

Need to weigh up pros and cons; slight increase risk of haemorrahgic stroke

Question 39

How is dysphagia managed post-stroke?

Answer 39

Initial swallow screen, if abnormal then a formal assessment by a speech and language therapist May need NG tube placement or textured diet and thickened lfuids

Question 40

How quickly should patients have their swallow assessed post stroke?

Answer 40

4 hours of arrival at hospital and before being given any oral food, fluid or medication

Question 41

How quickly should an NG tube be placed?

Answer 41

Within 24 hours

Question 42

What are C, D and E textured diets?

Answer 42

E; fork mashable dysphagia diet D; pre-mashed dysphagia diet C; thick puree dysphagia diet