Stroke COPY

Question 1

What is the definition of a stroke?

Answer 1

• CNS infarction
• Based on evidence of:
  
  • Focal ischaemic injury in vascular distribution
  • Clinical evidence
• With other causes excluded

Question 2

What happens to the brain when a stroke occurs?

Answer 2

• Blood flow stops
• Neurones depolarised
  
  • Onset of early symptoms
• Brain tissue dies

Question 3

How can more brain death be prevented in stroke?

Answer 3

By restoring the blood flow as soon as possible

Question 4

Draw a diagram of the circle of willis

Answer 4

Question 5

Answer 5

Question 6

Answer 6

Question 7

If there is right sided body weakness, which part of the brain is affected?

Answer 7

Left cerebral hemisphere

Question 8

Answer 8

Question 9

What will a stroke of the middle cerebral artery cause?

Answer 9

Face and arm weakness

Question 10

Answer 10

Question 11

Where is Brocas area of the brain?

What is its function?

Answer 11

Left frontal lobe

Speech production

Question 12

What is Wernickes area?

What is its function?

Answer 12

Posterior superior temporal gyrus

Understanding and producing meaningful speech

Question 13

Answer 13

Question 14

What visual change would occur with a stroke in this area?

Answer 14

Right homonymous hemianopia

Question 15

If a patient came in with acute light-headedness with past-pointing and nystagmus, where would the stroke be?

Answer 15

Cerebellum

Question 16

Answer 16

F.

Question 17

What is pictured here?

Answer 17

Harmorrhagic stroke on the left

Ischaemic stroke on the right

Question 18

How do you differentiate between different types of stroke?

Answer 18

MRI head

Question 19

What is an ischaemic stroke?

Answer 19

Episode of neurological dysfunction caused by an infarction

Question 20

What are some of the causes of ischaemic stroke?

Answer 20

• Cryptogenic
• Cardiac embolism
• Small vessel disease
• Atherosclerotic cerebrovascular disease

Question 21

What are the different categories of stroke under the Oxford community stroke project?

Answer 21

• Total anterior circulation syndrome (TACS)
• Partial anterior circulation syndrome (PACS)
• Posterior circulation syndrome (POCS)
• Lacunar syndrome (LACS)

Question 22

Describe TACS?

Answer 22

• Usually proximal MCA or ICA occlusion
  
  • Hemiparesis
  • Hemianopia
  • Higher cortical dysfunction

Question 23

Describe PACS?

Answer 23

• MCA branch occlusion
  
  • Isolated higher cortical dysfunction
  • OR
  • Any 2 of hemiparesis, higher cortical dysfunction, hemianopia

Question 24

Describe POCS?

Answer 24

• Perforating arteries, PCA or cerebellar arteries
  
  • Isolated hemianopia
  • OR
  • Brainstem syndrome

Question 25

Describe LACS?

Answer 25

* Small vessel disease * Pure motor stroke * Pure sensorys troke * Sensorimotor stroke * Ataxia hemiparesis * Clumsy hand-dysarthria

Question 26

Answer 26

Question 27

What is the definition of an intracerebral haemorrhage?

Answer 27

Collection of blood within the brain parenchyma or ventricules that is not caused by trauma.

Question 28

What is the definition of stroke caused by intracerebral haemorrhage?

Answer 28

Rapidly developing clinical signs of neurological dysfunction attributable to a focal collection of blood within the brain parenchyma or ventricular system that is not caused by trauma.

Question 29

What are the causes of intracranial bleeds?

Answer 29

* Trauma * Tumours * Small vessel disease * Cocaine / Amphetamines * Blood clotting deficiencies

Question 30

Describe the management of an ischaemic stroke?

Answer 30

* Aspirin * Stroke unit * IV thrombolysis * Hemicranectomy

Question 31

Describe the management of an haemorrhagic stroke (due to intracerebral bleed)?

Answer 31

* BP control * Stroke unit * Neurosurgical evacuation

Question 32

Describe hyper-acute treatments for ischaemic stroke?

Answer 32

* Thrombolysis * Within 4 hours of symptom onset * Thrombectomy * Within 8 hours of symptom onset * Stroke unit * Prevent aspiration

Question 33

What explains most causes of ischaemic stroke?

Answer 33

Cerebrovascular risk factors

Question 34

Name some cerebrovascular risk factors?

Answer 34

* High BP * Obesity * Smoking

Question 35

Describe potential investigations into stroke?

Answer 35

* CT (1st line) * MRI if diagnostic doubt * Duplex US of carotid and vertebral arteries * Intra-arterial angiography

Question 36

Clinical features of stroke?

Answer 36

* Weakness * Speech disturbance * Ataxia (if cerebellum involved)

Question 37

Describe an ischaemia stroke?

Answer 37

* Thromboembolic disease * Secondary to atherosclerosis in the major extracranial arteries * Carotid, aortic arch

Question 38

Describe a haemorrhagic stroke?

Answer 38

* Rupture of a blood vessel within the brain parenchyma * Can occur in SAH if the artery ruptures into the brain substance as well as the subarachnoid space

Question 39

Name some structural stroke mimics?

Answer 39

* Cerebral tumours * Extradurall/subdural haematoma * Cerebral abscess

Question 40

Name some functional stroke mimics?

Answer 40

* Hypoglycaemia * Focal seizures * Migranous aura

Question 41

What is a TIA?

Answer 41

* Symptoms resolve within 12 hours * Includes amaurosis fugax

Question 42

What is a progressive stroke?

Answer 42

* Focal neurological deficit worsens after the patient presents * Increasing infarction volume, increasing cerebral blood/oedema

Question 43

What is a completed stroke?

Answer 43

Focal deficit persists but does not worsen

Question 44

Management flow chart for stroke

Answer 44

Question 45

Management of secondary stroke risk factors

Answer 45