Stroke

Question 1

Outline the aetiology of stroke

Answer 1

• 85% ischemic

- 15% haemorrhagic

Question 2

What are the causal factors in intracerebral haemorrhage?

Answer 2

Anatomical factors:
-small vessel disease; amyloid angiopathy, AVMs
Haemodynamic factors:
- hypertension
Haemostatic factors: 
-anticoagulants; anti-platelets; thrombolytics 
Other factors:
-Recreational drugs, vasculitis

Question 3

What is amyloid angiopathy?

Answer 3

• Amyloid deposition in cortical artery muscle layers
• Typically causes: lobar intracerebral haemorrhage (ICH) and ICH at grey/white matter border
• prone to recurrence

Question 4

Which patients require an URGENT brain scan?

Answer 4

• Unconscious
• deteriorating conscious level
• on anticoagulants
• presentation within thrombolysis window of opportunity

Question 5

What are the different causes of ischemic stroke?

Answer 5

• AF
• Flow reducing carotid stenosis
• Penetrating artery disease
• Valve disease
• Left ventricular thrombi
• Cardiogenic emboli
• Carotid plaque with arteriogenic emboli
• Intracranial atherosclerosis

Question 6

What do the cortical branches of the MCA supply?

What are the exceptions ?

Answer 6

• The cortical branches of the MCA supply the lateral surface of the hemisphere
• Except for the medial part of the frontal & parietal lobe ( anterior cerebral artery) and the inferior part of the temporal lobe&occipital lobe ( posterior cerebral artery)

Question 7

What is the importance of Wernicke’s area in the brain?

Answer 7

comprehension of speech; language development; sensory area

Question 8

What is the importance of Broca’s area in development?

Answer 8

controls motor function in the production of speech

Question 9

What may be the presentation of a lesion in a large vessel- ACA territory

Answer 9

ACA= anterior cerebral artery

• Contralateral hemiparesis: leg more than arm/face
• Cortical signs: emotional changes; dysphasia( left anterior cerebral artery- Broca’s area)

Question 10

What may a patient with a lesion in the MCA territory present with?

Answer 10

-Contralateral hemiparesis: arm/face more than leg
-Contralateral hemisensory loss
-Cortical signs:
Contralateral hemianopia
Contralateral hemineglect
Dysphasia (left MCA)

Question 11

What may a patient with a lesion in the PCA territory present with?

Answer 11

• Contralateral hemianopia

- Contralateral hemineglect

Question 12

What may a patient with a lesion in the Vertebrobasilar territory present with?

Answer 12

• Nausea & Vomiting
• Diplopia
• Vertigo & nystagmus
• Ataxia
• Hemi/quadriplegia
• Visual field defect
• Coma

Question 13

What causes Lacunar stroke/ lacunar infacrt (LACI) ?

Answer 13

• It is the most common type of ischaemic stroke
• results from the occlusion of small penetrating arteries that provide blood to the brain’s deep structures.
• It is in n deep non-cortical white matter or the brainstem

Question 14

What may someone with lacunar stroke present with?

Answer 14

• No cortical features
• Pure hemiparesis
• Pure hemisensory loss
• Sensorimotor stroke
• Ataxic hemiparesis

Question 15

What are the characteristics of transient ischemic attacks?

Answer 15

TIAs are:

• Characterised by an acute loss of focal cerebral or monocular function
• Symptoms lasting less than 24 hours
• Due to inadequate cerebral/ocular blood supply
• Result of arterial thrombosis or embolism (artery, cardiac, haematological disease)
• Clinical diagnosis without specific diagnostic test
• Rely on constellation of clinical features

Question 16

What are the causes of transient focal neurological attacks?

Answer 16

• Focal cerebral ischaemia ie TIA
• Migraine aura (with/without headache)
• Partial (focal) epilepsy
• Labyrinthine disturbances
• Meniere’s disease
• BPPV
• Benign recurrent vertigo
• Labyrinthitis/vestibular neuronitis
• Transient global amnesia (TGA)
• Multiple sclerosis

Question 17

Outline the characteristics of an epileptic attack

Answer 17

-Focal sudden positive sensory or motor phenomena
-Spread quickly to adjacent body parts over ± 1
minute
-Versus TIA where tingling will arise in affect parts of
the body at the same time
-Migraine is over minutes
-May be focal jerking
-Altered awareness

Question 18

What is a positive Babinski reflex

Answer 18

• aka extensor plantar reflex
• Normal response= flexor planar reflex
• This reflex happens upon stroking the sole of the foot
• May be indicative or nerve disease or damage
• May be accompanied by fanning (of the foot

Question 19

What is the NIH Stroke Scale (NIHSS)

Answer 19

• Aka National Institutes of Health Stroke Scale

- A tool used by healthcare providers to objectively quantify the impairment caused by a stroke

Question 20

What are intermittent pneumatic compression devices?

Answer 20

• IPC devices are used to help prevent DVT of the legs
• The devices use cuffs around the legs that fill with air& squeeze your legs
• This increases blood flow through the veins of your legs and prevents thrombosis.

Question 21

Outline the treatment options for acute stroke

Answer 21

• TPA: ‘clot buster medicine’; dissolves clot

- THROMBECTOMY:minimally invasive for larger clots

Question 22

How can medication be used to prevent stroke

Answer 22

• Aspirin to reduce chance of clotting

- Blood thinners for people with abnormal heart rhythms eg AF

Question 23

How can we diagnose stroke

Answer 23

• CT scan(can show where blood flow is blocked)

- Flair MRI(can distinguish a new stroke injury from an old one)