W8: Stroke

Question 1

Stroke Pathophys.

Answer 1

THROMBUS/CLOT => ischaemia

VASC. WALL DISEASE

HAEMORRHAGE => pressure from leak + inflamm reaction; small vessels, AMYLOID deposition (RF),

• penumbra: viable tissue surrounding dead site of pathology supported by COLLATERAL FLOW
• TIA: onset of deficit <24hrs

Question 2

Small & Large Artery Disease

Answer 2

1. LACUNAR: occlusion of MEDIAL LATERAL STRIATE arteries. Isolated. HYPERTROPHIED WALL.
2. LARGE ARTERY DISEASE
   * CAROTID STENOSIS => Bifurcation; Atheroma +embolisation to brain via middle cerebral art.
   * CARDIOEMBOLIC STROKE => AF - LA clot -> embolise
   * CAROTID DISSECTION => lining of vessel tears => thrombus and embolisation.

Question 3

Process of Ischaemia to Excitoxicitiy

Answer 3

1. ISCHAEMIA -> NECROSIS -> OEDEMA
2. continuous Ca influx mediated by GLUTAMATE, ampa, failure of ion pumps
3. Cellular overexcitation => protease, lipase, FR release
4. ↑Permeability = ↑Ion Influx
5. Mito. breakdown => vicious cycle

=> BBB breakdown and consequent brain injury

Question 4

Major vascular pathways of embolus and resulting symptoms

Answer 4

INT. CAROTID > MID CEREBRAL > ANT. CEREBRAL

1. ANT. CEREBRAL OCCL. = contralateral l. limb paralysis, gait stance
2. MCA OCCL. = contralat. paralysis, sensory, aphasia,

VERTEBRAL ART > BASILLAR ART. > POST CEREBRAL > CEREBRAL ART.

1. POSTERIOR STROKE = coma, dizziness, nausea, ataxia, hemisensory
2. PONS = locked in syndrome (basilar occ.)

Question 5

Total and Partial Stroke Classifications

Answer 5

TACS: high mortality and death

PACS: low mort., recurrent.

LACS: low mort. recurrent

POCS: high mort. recurrent.

Question 6

Stroke Mgmt and Tx

Answer 6

• risk factor management: DAPT (post-TIA)
• ALTEPLASE thrombolysis within 4 hours
• bleeding risk