stroke- presentation

Question 1

whats the commonest cause of long term disability in the uk?

Answer 1

stroke

Question 2

how many NHS beds to people who have had strokes occupy?

Answer 2

20%

Question 3

what is a stroke?

Answer 3

neurological deficet of sudden onset lasting more than 24 hours

Question 4

what are stroke symptoms?

Answer 4

Loss of power

Loss of sensation

Loss of speech

Loss of vision

Loss of coordination

Question 5

what part of the body does stroke effect?

Answer 5

brain- due to a blockage of a blood vessel by thrombus or embolus

Question 6

what part of the brain is supplied by the carotid system?

Answer 6

most of the hemispheres and cortical deep white matter

Question 7

what part of the brain does the vertebro basilar system supply?

Answer 7

brain stem, cerebellum and occipatl lobes

Question 8

whats the function of the sensory cortex?

Answer 8

pain, heat and other sensations

Question 9

whats the function of tge temporal lobe?

Answer 9

hearing, intellectual and emotional functions

Question 10

whats the function of the parietal lobe?

Answer 10

comprehension of language

Question 11

whats the function of the occipital lobe?

Answer 11

primary visual area

Question 12

whats the function of wernicke’s area

Answer 12

speech comprehension

Question 13

whats the function of the cerebellum

Answer 13

coordination

Question 14

whats the function of the brainstem?

Answer 14

swallowing, breathing, heartbeat, wakefulness centre and other involuntary functions

Question 15

whats the function of the frontal lobe?

Answer 15

smell, judgement, foresight and voluntary movement

Question 16

whats the function of broca’s area?

Answer 16

speech

Question 17

what causes a stroke?

Answer 17

blockage of a vessel with thrombus or clot

disease of vessel wall

distrubance of normal properties of blood

rupture of vessel wall

Question 18

whats the commonest cause of cardioembolic stroke?

Answer 18

atrial fibrillation

Question 19

what part of the brain can be affected by a stroke?

Answer 19

left or right
carotid territory or vertebrobasilar
cerebral hemispheres or brainstem
cortex or deep white matter

Question 20

what would a brainstem stroke be?

Answer 20

wether the lesion is in the brainstem

Question 21

what would a cortical stroke be?

Answer 21

wether there is a lesion in the cortex

Question 22

what would a lacunar stroke be?

Answer 22

if the lesion is in the deep white matter

Question 23

what example of lesion would be unilateral field loss?

Answer 23

left optic nerve compression

Question 24

what example of lesion would be bitemporal hemianopia?

Answer 24

chiasmal compression from pituitary tumour

Question 25

what example of lesion would be homonymous hemianopia?

Answer 25

left cerebrovascular event

Question 26

what are characteristics sof total anterior circulation TACS?

Answer 26

20% of strokes patient usually has weakness, sensory deficit homonymous hemianopia higher cerebral dysfunction

Question 27

what are the characteristics of partial anterior circulation? PACS

Answer 27

35% strokes 2 of 3 TAACS criteria or restricted motor/sensory deficit

Question 28

what are caracteristics of lacunar strokes? LAC

Answer 28

20% strokes ``` pure motor (commonest) complete or incomplete weakness of 1 side ``` pure sensory sensory symptoms, same distribution sensorimotor combination of the above ataxic hemiparesis hemiparesis and ipsilateral cerebellar ataxia small infarcts in basal ganglia or pons. intrinsic disease of single basal perforating artery

Question 29

what are charactristics of posterior circulation? POCs

Answer 29

25% strokes affecting brainstem, cerebellar or occipital lobes ``` frequently complex presentation, may include bilateral motor/sensory deficit disordered conjugate eye movement isolated homonymous hemianopia ipsilateral cranial nerve palsy with contralateral motor/sensory deficit coma disordered breathing tinnitus vertigo Horner’s ```

Question 30

what type of stroke has the highest mortality at one year?

Answer 30

TACs

Question 31

what type of stroke has the smallest mortality at one year?

Answer 31

LACs

Question 32

what type of stroke has the highest recurring rate at one year?

Answer 32

POCs

Question 33

risk factors for stroke

Answer 33

Modifiable High blood pressure Atrial fibrillation Non-modifiable Age Race Family history

Question 34

what are the investigations for stroke?

Answer 34

blood tests: full blood count, lipids | ECG

Question 35

what imaging would you use for stroke?

Answer 35

CT scan MRI scan carotid doppler

Question 36

whats better a CT or mri snd why?

Answer 36

CT Quick Shows up blood MRI scan Takes up to 30 minutes Claustrophobic Shows up ischaemic stroke better that CT does

Question 37

how can you harm someone with a stroke?

Answer 37

Alteplase Cause unexpected bleeding either in the brain if tissue has established damage If brain tissue already dead restoring blood supply is not going to help Or bleeding elsewhere (e.g. Gut)

Question 38

whats the first thng a patient with a stroke should have to treat?

Answer 38

0.9 mg/kg intravenous rt-PA

Question 39

should patients with suspected stroke have priority over others for ambulance etc?

Answer 39

yes

Question 40

contraindications to thrombolysis?

Answer 40

Age Most RCTs have excluded those under 16 and over 80 yrs Licence currently limited to <80yr Stroke outcomes worse anyway in over 80s Greater age perceived as greater risk of bleeding Lots of case series reporting good outcomes in older patients treate

Question 41

what surgery would you do for a patient that has had a stroke?

Answer 41

thrombolysis

Question 42

what is the majority age of stroke patients?

Answer 42

over 65

Question 43

how do you tell the difference between haemorhage and infarct on a scan?

Answer 43

in a ct scan, black image is infarct as there is more fluid | white image is haemorrhage

Question 44

how often is a stroke ischaemic and how often is it haemorrhage?

Answer 44

85% ischaemic | 15% haemorrhage

Question 45

whats the difference between haemorrhage stroke and ischaemic stroke?

Answer 45

haemorrhage/blood leaks into brain tissue ischaemic: clot stops blood supply to an area of the brain

Question 46

what are the main causes for ischaemic strokes?

Answer 46

large artery atherosclerosis cardioemboic (atrial fibrilation) small artery occlusion