Stroke

Question 1

What is a cardioembolic stroke?

Answer 1

An embolism which travels from the heart to block a blood vessel higher up

Question 2

What is the biggest risk factor for stroke?

Answer 2

Transient Ischaemic Attack (TIA)

Question 3

Name 5 risk factors for stroke, excluding TIA

Answer 3

1. Hypertension
2. Smoking
3. Diabetes
4. Obesity
5. Lifestyle (diet, alcohol and drug use)

Question 4

Name 4 uncontrollable risk factors for stroke

Answer 4

1. Family history
2. Increased age
3. Being male
4. African / Asian / Hispanic background

Question 5

Name 2 types of stroke

Answer 5

1. Atherosclerosis

2. Embolism

Question 6

What does ICH stand for?

Answer 6

Intra-cerebral haemorrhage

Question 7

Name 5 risk factors for ICH

Answer 7

1. Prolonged HTN
2. Amyloid Angiopathy
3. Age
4. Head trauma
5. Structural abnormalities e.g Cavernoma

Question 8

Describe how antithrombotic drugs may be viewed ask a risk factor with regards to ICH

Answer 8

These drugs will not typically cause a bleed but will make a bleed much worse when it occurs

Question 9

Describe the slogan used for how to act if a person is having a suspected stroke

Answer 9

F - Face drooping on one side
A - Arms unable to raise on one side
S - Speech is slurred
T - Time to call 999

Question 10

Describe 2 important questions when determining if a person is having a stroke

Answer 10

Does it look like a stroke?

Question 10

Describe 2 important questions when determining if a person is having a stroke

Answer 10

Does it look like a stroke?
Onset and course
General and focal symptoms (negative symptoms)

Is the patient at risk of a stroke?

Question 11

Name 5 conditions which may mimic a stroke

Answer 11

1. Migraine
2. Epilepsy
3. Structural brain lesions (tumour, abscess etc)
4. Psychological disorders
5. Demyelination

Question 12

Name 5 reasons an urgent CT is needed in case of suspected stroke

Answer 12

1. Depressed levels of concoction
2. Papilloedema, neck stiffness or fever
3. Severe headache at onset
4. Thrombolysis being considered
5. Unexplained progressive symptoms

Question 13

Describe the relationship of blood flow and neuronal function from the core area

Answer 13

• At core there is irreversible damage occuring which expends out to the surrounding tissue
• In the part around the core there is reversible damage occuring but will turn to irreversible if left for too long
• Rate at which brain damage occurs varies from person to person

Question 14

What is the ischaemic penumbra?

Answer 14

Area of the brain where blood supply has decreased but the part of the brain has not yet died

Question 15

What is thrombectomy>

Answer 15

Fine wire put into the brain and the clot is physically removed using stent remover

Question 16

What is the most common treatment for a stroke, given no contra-indications?

Answer 16

Thrombolysis

Question 17

Name 4 types of stroke in the Oxford classification

Answer 17

1. TACS
2. PACS
3. LACS
4. POCS

Question 18

Describe collateral circulation in the brain

Answer 18

• Carotid artery supplies anterior of the brain
• Vertebral artery supplies posterior of the brain
• Circle of Willis connects the two so if one becomes occluded, there is still some supply to the part it supplies

Question 19

Describe TACS

Answer 19

• Total anterior circulation infarct
• Higher cortical dysfunction
• Hemiparesis
• Homonymous hemianopia

Question 20

Describe LACS

Answer 20

• Lacunar infarct
• Motor or sensory stroke affecting face, arms and legs
• Does not cause cortical dysfunction

Question 21

Describe PACS

Answer 21

• Partial anterior circulation stroke

- Includes 1 or 2 symptoms of TACS but not all 3

Question 22

Describe POCS

Answer 22

• Posterior circulation stroke syndrome
• Cranial nerve palsies
• Bilateral motor / sensory loss
• Cerebellar dysfunction

Question 23

Describe the survival of patients suffering from LACS, TACS, PACS and POCS

Answer 23

LACS - 2% death
TACS - 39% death
PACS - 4% death
POCS - 7% death

Question 24

Describe the relationship between oral hygeine and cardiovascular disease

Answer 24

- Poor oral hygeine is associated with higher levels of risk of cardiovascular disease - Periodontitis has 25% increase of CHD

Question 25

Name an example of surgery to treat CHD

Answer 25

Carotid endarterectomy

Question 26

Name 4 complications of CEA

Answer 26

1. Death / Stroke / MI 2. Hyperperfusion syndrome 3. Nerve injury 4. Parotitis

Question 27

Name 3 facial symptoms of a stroke

Answer 27

1. Oropharyngeal anaesthesia 2. Facial pain or tingling 3. Flattening nasolabial fold

Question 28

Describe peri-procedural dental management of patients taking antithrombotic medications

Answer 28

- Medications remain in the system for up to 7 days after stopping - Continue aspirin when undergoing dental procedures - Given minimal bleeding risks, undergo dental procedures should continue warfarin

Question 29

Name 4 cardiac conditions at risk of developing infective endocarditis

Answer 29

1. Acquired valvular heart disease with stenosis 2. Valve replacement 3. Structural congenital heart disease 4. Previous IE

Question 30

Describe antibiotic prophylaxis against IE for dental procedures in a person with cardiac conditions

Answer 30

- Do not routinely offer prophylaxis (consider in higher risk patients) - Do not offer chlorhexidine mouthwash prophylaxis - Informed consent very important