p.35
Types and Subtypes of Stroke
What are lacunar syndromes?
Lacunar syndromes are a type of stroke that occurs due to the occlusion of small penetrating arteries.
p.62
Types and Subtypes of Stroke
What are the two main types of hemorrhagic stroke?
Intracerebral Hemorrhage and Subarachnoid Hemorrhage
p.24
Management and Treatment Strategies for Acute Stroke
What does the phrase 'Time is brain' imply in the context of stroke?
It implies that the quicker a stroke is treated, the less brain damage occurs.
p.15
Types and Subtypes of Stroke
What causes a haemorrhagic stroke?
A blood vessel in the brain bursts, leading to bleeding in or around the brain.
p.6
Epidemiology and Global Burden of Stroke
What are the global implications of strokes?
Strokes contribute significantly to healthcare costs and loss of productivity, impacting economies and healthcare systems globally.
p.5
Definition and Classification of Stroke
What is a Transient Ischemic Attack (TIA)?
An ischemic event lasting less than 24 hours without apparent permanent neurological deficits.
p.60
Management and Treatment Strategies for Acute Stroke
What kind of equipment does an acute stroke unit have access to?
Equipment for monitoring and rehabilitating patients.
p.28
Pathophysiology of Ischaemic Brain Injury
Which arteries form the Circle of Willis?
The internal carotid arteries and the basilar artery.
p.33
Types and Subtypes of Stroke
What are the types of cerebral arterial ischemic syndromes?
Middle cerebral (Proximal/Distal), Anterior cerebral (Proximal/Distal), Internal carotid, Posterior cerebral, Vertebro-basilar, Posterior inferior cerebellar (Lateral medullary).
p.45
Diagnosis and Imaging Techniques for Stroke
What is the most sensitive sequence for stroke imaging?
Diffusion weighted images (DWI).
p.25
Risk Factors for Ischaemic Stroke
What sudden cognitive changes can indicate a stroke?
Sudden confusion, trouble speaking, or understanding.
p.18
Aetiology of Ischaemic and Haemorrhagic Strokes
What factors contribute to stasis or turbulent blood flow in thrombotic ischemic strokes?
Atherosclerosis, atrial fibrillation (A. fib.), and valve disorders.
p.66
Diagnosis and Imaging Techniques for Stroke
What types of underlying structural lesions can be evaluated using CTA/CTV, MRI with gadolinium, and MRA/MRV?
Vascular malformations and/or tumors.
p.43
Diagnosis and Imaging Techniques for Stroke
What does DWI 'bright-up' indicate in the context of stroke?
It indicates an acute ischemic stroke.
p.4
Definition and Classification of Stroke
What is the definition of a stroke according to the WHO?
A stroke is characterized by rapidly developing clinical signs of focal (at times global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.
p.43
Diagnosis and Imaging Techniques for Stroke
How does DWI help in stroke diagnosis besides detecting acute ischemic stroke?
It helps in differentiating between new and old lesions.
p.58
Management and Treatment Strategies for Acute Stroke
What are the prevention strategies for stroke management?
Endarterectomy and stenting.
p.25
Risk Factors for Ischaemic Stroke
What visual disturbances can be a warning sign of a stroke?
Sudden trouble seeing in one or both eyes.
p.31
Pathophysiology of Ischaemic Brain Injury
What is the significance of the posterior cerebral arteries in brain circulation?
They supply blood to the occipital lobes and the inferior parts of the temporal lobes.
p.65
Diagnosis and Imaging Techniques for Stroke
What does the SPOT sign look like on a CTA scan?
It appears as white arrows.
p.26
Types and Subtypes of Stroke
How can ischemic strokes be classified by vascular territory?
Ischemic strokes can be classified into anterior circulation (carotid arteries) and posterior circulation (vertebrobasilar system).
p.24
Management and Treatment Strategies for Acute Stroke
Why is rapid treatment crucial in the event of a stroke?
Rapid treatment is crucial because it can significantly reduce the extent of brain damage and improve recovery outcomes.
p.31
Pathophysiology of Ischaemic Brain Injury
What arteries primarily supply the posterior circulation of the brain?
The vertebral arteries and the basilar artery.
p.18
Aetiology of Ischaemic and Haemorrhagic Strokes
What are the three components of Virchow's Triad in the etiology of thrombotic ischemic strokes?
Blood vessel injury, stasis/turbulent blood flow, and hypercoagulable state.
p.29
Aetiology of Ischaemic and Haemorrhagic Strokes
Which artery is part of the anterior circulation of the brain?
The internal carotid artery.
p.45
Diagnosis and Imaging Techniques for Stroke
Which types of infarcts can be detected using DWI?
Posterior circulation infarct, Anterior circulation infarct, and MCA infarct.
p.49
Management and Treatment Strategies for Acute Stroke
What is important for the prevention and treatment of medical and neurological complications in stroke patients?
Comprehensive medical care and monitoring.
p.33
Types and Subtypes of Stroke
Which cerebral artery ischemic syndrome involves the vertebro-basilar system?
Vertebro-basilar ischemic syndrome.
p.45
Diagnosis and Imaging Techniques for Stroke
For how long will DWI remain positive after the onset of brain infarction?
Approximately for 3 weeks.
p.44
Diagnosis and Imaging Techniques for Stroke
What does MRA stand for in multimodal MRI imaging?
Magnetic Resonance Angiography.
p.10
Epidemiology and Global Burden of Stroke
How does the incidence of stroke vary with geography?
In the US, there are 795,000 strokes per year, and in the UK, there are 152,000 strokes per year.
p.40
Pathophysiology of Ischaemic Brain Injury
What does swelling indicate in the context of a cerebral infarction?
Swelling indicates edema or fluid accumulation in the brain tissue, which can increase intracranial pressure.
p.51
Management and Treatment Strategies for Acute Stroke
What is another critical objective in the management of acute stroke?
Prevent death due to cerebral/systemic effects.
p.5
Definition and Classification of Stroke
What characterizes a stroke in evolution?
Progressive neurological deficits over time suggesting a widening of the area of ischemia.
p.6
Epidemiology and Global Burden of Stroke
Why is it important to focus on strokes?
Strokes are a leading cause of death and disability worldwide, making it crucial to understand and address their prevention, treatment, and rehabilitation.
p.75
Rehabilitation and Quality of Life After Stroke
What is one of the goals of stroke rehabilitation related to medical conditions?
To prevent, recognize, and manage co-morbid medical conditions.
p.57
Risk Factors for Ischaemic Stroke
What are some non-pharmacological interventions for managing stroke risk factors?
Lifestyle modifications such as cessation of smoking and alcohol, exercise, and weight reduction.
p.38
Diagnosis and Imaging Techniques for Stroke
What types of cardiac imaging are used in stroke diagnosis?
TTE, TEE, and heart monitoring.
p.33
Types and Subtypes of Stroke
Which cerebral artery ischemic syndrome can be classified as proximal or distal?
Middle cerebral and Anterior cerebral.
p.57
Risk Factors for Ischaemic Stroke
What are some pharmacological interventions for managing stroke risk factors?
Management of diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, cardiac diseases, and symptomatic carotid stenosis.
p.49
Management and Treatment Strategies for Acute Stroke
What is a key component in the management of acute stroke?
Immediate medical intervention and treatment.
p.31
Pathophysiology of Ischaemic Brain Injury
What are the main branches of the basilar artery?
The posterior cerebral arteries, superior cerebellar arteries, and anterior inferior cerebellar arteries.
p.44
Diagnosis and Imaging Techniques for Stroke
What does PWI stand for in multimodal MRI imaging?
Perfusion-Weighted Imaging.
p.49
Secondary Prevention of Stroke
What is a strategy to prevent recurrent strokes?
Implementing secondary prevention measures.
p.67
Management and Treatment Strategies for Acute Stroke
What are two options for reversing warfarin in patients with ICH?
Fresh frozen plasma (FFP) or prothrombin complex concentrates.
p.37
Types and Subtypes of Stroke
Which syndrome includes Horner’s syndrome as a symptom?
Lateral Medullary (PICA) Syndrome.
p.21
Pathophysiology of Ischaemic Brain Injury
What happens when there is inadequate perfusion in the brain?
Tissue death and functional deficit
p.40
Pathophysiology of Ischaemic Brain Injury
What is focal cortical effacement?
Focal cortical effacement is the loss of the normal contours of the brain's cortex, often due to swelling or mass effect from a cerebral infarction.
p.55
Management and Treatment Strategies for Acute Stroke
What procedures should be delayed during Alteplase therapy?
Placement of nasogastric tubes, indwelling bladder catheters, or intraarterial pressure catheters.
p.72
Rehabilitation and Quality of Life After Stroke
What is available for stroke survivors to aid in their recovery?
Support, resources, and rehabilitation.
p.35
Aetiology of Ischaemic and Haemorrhagic Strokes
What causes lacunar syndromes?
Lacunar syndromes are caused by the occlusion of small vessels in the brain.
p.51
Management and Treatment Strategies for Acute Stroke
What is one of the primary goals in the management of acute stroke?
Minimise neuronal damage.
p.46
Diagnosis and Imaging Techniques for Stroke
What does blue indicate in stroke imaging?
Mismatch, which is the penumbra.
p.72
Rehabilitation and Quality of Life After Stroke
What can provide hope for stroke survivors?
Support, resources, and rehabilitation.
p.60
Management and Treatment Strategies for Acute Stroke
What is an acute stroke unit?
A discrete area in the hospital staffed by a specialist stroke multidisciplinary team.
p.65
Diagnosis and Imaging Techniques for Stroke
What does the SPOT sign indicate in a CTA scan?
CT contrast extravasates into the hematoma.
p.66
Diagnosis and Imaging Techniques for Stroke
What imaging techniques can be used to evaluate underlying structural lesions?
CTA/CTV, MRI with gadolinium, MRA/MRV.
p.15
Types and Subtypes of Stroke
What are the two major types of stroke?
Ischaemic stroke and haemorrhagic stroke.
p.60
Management and Treatment Strategies for Acute Stroke
Who staffs an acute stroke unit?
A specialist stroke multidisciplinary team.
p.15
Types and Subtypes of Stroke
What causes an ischaemic stroke?
A blockage in an artery that supplies blood to the brain.
p.28
Pathophysiology of Ischaemic Brain Injury
What is the Circle of Willis?
A circular network of arteries located at the base of the brain.
p.19
Aetiology of Ischaemic and Haemorrhagic Strokes
What are some heart-related causes of embolic ischemic stroke?
Valve diseases, atrial fibrillation, dilated cardiomyopathy, and myxoma.
p.65
Diagnosis and Imaging Techniques for Stroke
What can the presence of a SPOT sign predict?
It may predict hematoma expansion.
p.66
Diagnosis and Imaging Techniques for Stroke
When should imaging for underlying structural lesions be considered?
When there is clinical or radiologic suspicion.
p.24
Management and Treatment Strategies for Acute Stroke
How is the concept 'Time is brain' quantified in stroke treatment?
Every minute a stroke goes untreated, approximately 1.9 million neurons are lost.
p.60
Management and Treatment Strategies for Acute Stroke
What regular meetings occur in an acute stroke unit?
Regular multidisciplinary team meetings for goal setting.
p.19
Aetiology of Ischaemic and Haemorrhagic Strokes
What arterial circulation issues can lead to embolic ischemic stroke?
Atherosclerosis of the carotid artery, arterial dissection, and vasculitis.
p.29
Aetiology of Ischaemic and Haemorrhagic Strokes
From where does the internal carotid artery arise?
From the common carotid artery.
p.5
Definition and Classification of Stroke
What is a completed stroke?
An ischemic event with a persisted deficit.
p.28
Pathophysiology of Ischaemic Brain Injury
What is the primary function of the Circle of Willis?
To provide collateral blood flow to the brain in case of arterial blockage.
p.43
Diagnosis and Imaging Techniques for Stroke
What imaging technique is used to detect areas of restricted diffusion of water in acute ischemic stroke?
Diffusion-weighted imaging (DWI).
p.75
Rehabilitation and Quality of Life After Stroke
What is a key goal of stroke rehabilitation in terms of patient independence?
To maximize functional independence.
p.29
Aetiology of Ischaemic and Haemorrhagic Strokes
What are the branches of the internal carotid artery?
Anterior cerebral, anterior communicating, middle cerebral, and posterior communicating arteries.
p.6
Rehabilitation and Quality of Life After Stroke
How do strokes affect individuals and families?
Strokes can lead to long-term disability, affecting the quality of life of individuals and placing a significant emotional and financial burden on families.
p.26
Types and Subtypes of Stroke
What system is involved in posterior circulation ischemic strokes?
Vertebrobasilar (VB) system.
p.19
Aetiology of Ischaemic and Haemorrhagic Strokes
What venous circulation condition can contribute to embolic ischemic stroke?
Patent foramen ovale (PFO) with right-to-left shunt and emboli.
p.28
Pathophysiology of Ischaemic Brain Injury
How does the Circle of Willis contribute to brain protection?
By ensuring continuous blood supply even if one part of the arterial network is blocked.
p.6
Secondary Prevention of Stroke
What is the potential benefit of focusing on stroke prevention and treatment?
Improving stroke prevention and treatment can reduce mortality rates, enhance recovery outcomes, and decrease the overall burden on healthcare systems.
p.64
Diagnosis and Imaging Techniques for Stroke
What is recommended for distinguishing ischemic stroke from ICH?
Rapid neuroimaging with CT or MRI.
p.58
Management and Treatment Strategies for Acute Stroke
What are the acute management options for stroke?
Thrombolytics – both medical and mechanical.
p.10
Epidemiology and Global Burden of Stroke
What is the second leading cause of death worldwide?
Stroke, causing 5 million deaths each year.
p.49
Rehabilitation and Quality of Life After Stroke
What role does rehabilitation play in stroke management?
It helps in the recovery and improvement of quality of life after a stroke.
p.64
Diagnosis and Imaging Techniques for Stroke
What is the Class and Level of Evidence for using CT angiography and contrast-enhanced CT to identify patients at risk for hematoma expansion?
Class IIb, Level of Evidence B.
p.58
Pathophysiology of Ischaemic Brain Injury
What conditions can lead to decreased cerebral blood flow (CBF)?
Cerebral arterial stenosis/occlusion, large artery atherosclerosis (LAA), cardioembolism (CE), small vessel disease (SVD), and others.
p.44
Diagnosis and Imaging Techniques for Stroke
What is the purpose of Perfusion-Weighted Imaging (PWI) in MRI?
To assess perfusion status.
p.67
Management and Treatment Strategies for Acute Stroke
What is a potential risk associated with IV vitamin K administration?
A small risk of anaphylactoid reaction.
p.22
Pathophysiology of Ischaemic Brain Injury
What occurs when CBF drops to 15 ml/100g/min?
Loss of Na/K+ pump function.
p.41
Diagnosis and Imaging Techniques for Stroke
What does multimodal CT imaging assess in stroke patients?
Perfusion status, tissue status, and vessel status.
p.42
Differential Diagnosis of Stroke
What metabolic conditions can be mistaken for a stroke?
Hyperglycemia (nonketotic hyperosmolar coma) and hypoglycemia.
p.47
Management and Treatment Strategies for Acute Stroke
Why is rapid diagnosis and treatment crucial in acute stroke therapy?
Because the sooner blood flow is restored, the better the chances of minimizing brain damage and improving outcomes.
p.1
Secondary Prevention of Stroke
What are some strategies for secondary prevention of stroke?
Lifestyle changes, medications to control risk factors, and surgical interventions if necessary.
p.32
Types and Subtypes of Stroke
What is hemi-sensory loss?
Loss of sensation on one side of the body.
p.20
Risk Factors for Ischaemic Stroke
What are some modifiable risk factors for ischemic stroke?
Hypertension, Diabetes, Dyslipidaemia, AF/heart disease, Smoking, Alcohol consumption, Physical inactivity, Obesity, Dietary factors, Oral contraceptive use, Infection, Stress, Prothrombotic factors, Sleep apnea.
p.36
Pathophysiology of Ischaemic Brain Injury
What is crossed hemiplegia in the context of vertebro-basilar ischemia?
Crossed hemiplegia is a condition where one side of the face and the opposite side of the body are paralyzed.
p.36
Pathophysiology of Ischaemic Brain Injury
What does dissociated sensory loss mean in vertebro-basilar ischemia?
Dissociated sensory loss refers to the loss of certain types of sensation (e.g., pain and temperature) while other sensations (e.g., touch) remain intact.
p.63
Aetiology of Ischaemic and Haemorrhagic Strokes
What is the effect of drugs like cocaine on stroke risk?
Drugs like cocaine can increase blood pressure and cause blood vessel damage, leading to a higher risk of stroke.
p.49
Management and Treatment Strategies for Acute Stroke
What is one current strategy for managing stroke?
Treatment of risk factors in large populations.
p.28
Pathophysiology of Ischaemic Brain Injury
Which arteries branch off from the Circle of Willis to supply the brain?
The anterior cerebral arteries, middle cerebral arteries, and posterior cerebral arteries.
p.45
Diagnosis and Imaging Techniques for Stroke
When does DWI become positive in the case of brain infarction?
DWI is already positive in the acute phase.
p.61
Secondary Prevention of Stroke
What health parameters should be optimized for secondary stroke prevention?
Blood glucose, cholesterol, and blood pressure.
p.64
Diagnosis and Imaging Techniques for Stroke
What imaging techniques may be considered to help identify patients at risk for hematoma expansion?
CT angiography and contrast-enhanced CT.
p.37
Types and Subtypes of Stroke
Which syndrome is characterized by vertigo and vomiting?
Lateral Medullary (PICA) Syndrome.
p.78
Rehabilitation and Quality of Life After Stroke
What follows therapy during acute care in the levels of rehabilitation care?
Acute comprehensive inpatient rehabilitation.
p.37
Types and Subtypes of Stroke
What type of sensory loss is associated with Lateral Medullary (PICA) Syndrome?
Vth sensory loss and checker board sensory loss.
p.78
Rehabilitation and Quality of Life After Stroke
What is the third level of rehabilitation care?
Sub acute comprehensive inpatient rehabilitation.
p.58
Pathophysiology of Ischaemic Brain Injury
What is the role of cerebral autoregulation in stroke?
It involves maintaining stable cerebral blood flow despite changes in perfusion pressure, often influenced by endothelial function.
p.50
Rehabilitation and Quality of Life After Stroke
How can stroke-related disability be reduced?
Through rehabilitation and effective management of risk factors.
p.42
Differential Diagnosis of Stroke
Which infections can be considered in the differential diagnosis of stroke?
Meningitis and encephalitis.
p.69
Management and Treatment Strategies for Acute Stroke
What type of environment should a patient with SAH be nursed in?
Quiet, darkened surroundings.
p.74
Rehabilitation and Quality of Life After Stroke
Which specialist focuses on the recovery and rehabilitation of stroke patients?
Rehabilitation specialist.
p.1
Rehabilitation and Quality of Life After Stroke
Why is rehabilitation important after a stroke?
Rehabilitation helps stroke survivors regain as much independence and quality of life as possible.
p.32
Types and Subtypes of Stroke
What is hemiparesis?
Weakness on one side of the body.
p.23
Pathophysiology of Ischaemic Brain Injury
What is the penumbra in the context of an ischemic stroke?
The penumbra is the zone of reversible ischemia around the core of irreversible infarction, which is salvageable in the first few hours after stroke onset.
p.36
Pathophysiology of Ischaemic Brain Injury
What is internuclear ophthalmoplegia?
Internuclear ophthalmoplegia is a disorder of eye movement caused by a lesion in the medial longitudinal fasciculus, leading to impaired horizontal eye movements.
p.68
Aetiology of Ischaemic and Haemorrhagic Strokes
What does ICH stand for in the context of stroke?
Intracerebral Hemorrhage.
p.79
Rehabilitation and Quality of Life After Stroke
Why is addressing sexuality important in stroke rehabilitation?
Sexuality is a significant aspect of quality of life, and addressing it can help improve emotional intimacy and personal relationships after a stroke.
p.57
Risk Factors for Ischaemic Stroke
What lifestyle modifications can help reduce the risk of stroke?
Cessation of smoking, cessation of alcohol, exercise, and weight reduction.
p.31
Pathophysiology of Ischaemic Brain Injury
What is the role of the basilar artery in the posterior circulation?
It is formed by the union of the two vertebral arteries and supplies blood to the brainstem and cerebellum.
p.38
Diagnosis and Imaging Techniques for Stroke
What are the noninvasive vascular imaging techniques used for stroke diagnosis?
MR angiography (MRA) and CT angiography (CTA) for both intracranial and extracranial imaging, and ultrasound (Carotid, TCD).
p.38
Diagnosis and Imaging Techniques for Stroke
What is the invasive vascular imaging technique used for stroke diagnosis?
Conventional cerebral angiography.
p.25
Risk Factors for Ischaemic Stroke
What are some sudden motor coordination issues that can indicate a stroke?
Sudden trouble walking, dizziness/vertigo, loss of balance or coordination.
p.4
Definition and Classification of Stroke
Can a stroke involve global disturbance of cerebral function?
Yes, at times a stroke can involve global disturbance of cerebral function.
p.25
Risk Factors for Ischaemic Stroke
What type of headache is a warning sign of a hemorrhagic stroke?
Sudden, severe headaches with no known cause.
p.37
Types and Subtypes of Stroke
What are cerebellar signs in the context of Lateral Medullary (PICA) Syndrome?
Symptoms indicating cerebellar dysfunction, such as ataxia or coordination problems.
p.78
Rehabilitation and Quality of Life After Stroke
What type of rehabilitation care involves intensive therapy but allows patients to return home each day?
Comprehensive day rehabilitation.
p.21
Pathophysiology of Ischaemic Brain Injury
What key pathologic event is associated with ischemic brain injury?
Decrement in regional cerebral blood flow (CBF)
p.77
Rehabilitation and Quality of Life After Stroke
What type of pain and dysfunction is common in stroke patients?
Shoulder pain and dysfunction.
p.41
Diagnosis and Imaging Techniques for Stroke
What does CTA stand for in stroke imaging?
Computed Tomography Angiography.
p.42
Differential Diagnosis of Stroke
What substance-related condition can mimic stroke symptoms?
Drug or narcotic overdose.
p.32
Types and Subtypes of Stroke
What is dysphasia?
A language disorder marked by impaired ability to communicate.
p.63
Aetiology of Ischaemic and Haemorrhagic Strokes
How can tumors cause strokes?
Tumors can press on blood vessels or cause bleeding, leading to a stroke.
p.36
Pathophysiology of Ischaemic Brain Injury
What is checkerboard anesthesia?
Checkerboard anesthesia is a pattern of sensory loss where alternating areas of the body lose sensation.
p.36
Pathophysiology of Ischaemic Brain Injury
What are cerebellar signs in vertebro-basilar ischemia?
Cerebellar signs include symptoms such as ataxia, dysmetria, and intention tremor, indicating cerebellar dysfunction.
p.79
Rehabilitation and Quality of Life After Stroke
What are some quality of life issues that can be affected after a stroke?
Sexuality, spirituality, driving, employment, education, recreation, and family involvement.
p.36
Pathophysiology of Ischaemic Brain Injury
What are dysconjugate eye movements?
Dysconjugate eye movements occur when the eyes do not move together in a coordinated manner.
p.79
Rehabilitation and Quality of Life After Stroke
How can a stroke impact a person's ability to drive?
A stroke can affect physical and cognitive abilities, which may impair driving skills.
p.31
Pathophysiology of Ischaemic Brain Injury
Which areas of the brain are supplied by the posterior circulation?
The occipital lobes, cerebellum, and brainstem.
p.49
Management and Treatment Strategies for Acute Stroke
How are individuals at the highest risk for stroke managed?
Through targeted treatment strategies.
p.50
Risk Factors for Ischaemic Stroke
What are some key strategies for preventing a first stroke?
Managing blood pressure, controlling glucose levels, quitting smoking, and managing lipid levels.
p.18
Aetiology of Ischaemic and Haemorrhagic Strokes
What conditions can lead to a hypercoagulable state in thrombotic ischemic strokes?
Increased number of platelets, deficiency of anti-coagulation factors, presence of pro-coagulation factors, and cancer.
p.64
Diagnosis and Imaging Techniques for Stroke
What is the Class and Level of Evidence for using various imaging techniques to evaluate for underlying structural lesions when there is clinical or radiologic suspicion?
Class IIa, Level of Evidence B.
p.40
Pathophysiology of Ischaemic Brain Injury
What is ventricular compression in the context of a cerebral infarction?
Ventricular compression refers to the squeezing or narrowing of the brain's ventricles due to swelling or mass effect.
p.13
Epidemiology and Global Burden of Stroke
Is stroke preventable and treatable?
Yes, stroke is preventable and treatable.
p.21
Pathophysiology of Ischaemic Brain Injury
What is ischemic brain injury characterized by?
A series of interlocking thresholds known as the 'ischemic thresholds'
p.47
Management and Treatment Strategies for Acute Stroke
What is the time window for administering intravenous thrombolysis in acute ischemic stroke?
Within 4.5 hours of symptom onset.
p.1
Aetiology of Ischaemic and Haemorrhagic Strokes
What causes a haemorrhagic stroke?
A haemorrhagic stroke is caused by a blood vessel in the brain that bursts, leading to bleeding in or around the brain.
p.27
Aetiology of Ischaemic and Haemorrhagic Strokes
What is a common issue with carotid arteries?
They are frequently congested with plaque.
p.27
Management and Treatment Strategies for Acute Stroke
Why are vertebral arteries not accessible for surgical cleaning?
Because they are well protected and pass through the cervical vertebrae.
p.63
Aetiology of Ischaemic and Haemorrhagic Strokes
What role do infections play in causing strokes?
Infections can lead to inflammation and damage to blood vessels, increasing the risk of stroke.
p.68
Management and Treatment Strategies for Acute Stroke
Name one potential treatment strategy for managing hematoma expansion in ICH.
Rapid blood pressure control.
p.25
Risk Factors for Ischaemic Stroke
What is a common warning sign of a stroke related to muscle strength?
Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body.
p.75
Rehabilitation and Quality of Life After Stroke
What is a goal of stroke rehabilitation related to life roles and community?
To facilitate resumption of prior life roles and community reintegration.
p.57
Risk Factors for Ischaemic Stroke
Which medical conditions are targeted by pharmacological interventions to reduce stroke risk?
Diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, cardiac diseases, and symptomatic carotid stenosis.
p.75
Rehabilitation and Quality of Life After Stroke
How does stroke rehabilitation aim to improve the overall well-being of patients?
By enhancing quality of life.
p.78
Rehabilitation and Quality of Life After Stroke
What is the first level of rehabilitation care?
Therapy during acute care.
p.67
Aetiology of Ischaemic and Haemorrhagic Strokes
What effect does anticoagulation have on intracerebral hemorrhage (ICH)?
Anticoagulation leads to more hematoma growth and higher mortality.
p.50
Management and Treatment Strategies for Acute Stroke
How can stroke mortality be reduced?
Through acute treatment and effective secondary prevention strategies.
p.42
Types and Subtypes of Stroke
What are the two main types of stroke?
Ischemic stroke and hemorrhagic stroke.
p.74
Management and Treatment Strategies for Acute Stroke
Which medical specialist is primarily responsible for the treatment of stroke?
Stroke physician/neurologist.
p.47
Management and Treatment Strategies for Acute Stroke
What is mechanical thrombectomy?
A procedure to remove a blood clot from a large artery in the brain using a stent retriever or aspiration device.
p.27
Management and Treatment Strategies for Acute Stroke
How can carotid arteries be treated if they are congested with plaque?
They can be cleaned out surgically.
p.79
Rehabilitation and Quality of Life After Stroke
How can spirituality play a role in the recovery process after a stroke?
Spirituality can provide comfort, hope, and a sense of purpose, which can be beneficial for emotional and psychological recovery.
p.38
Diagnosis and Imaging Techniques for Stroke
What tests are included in lipid and coagulation testing for stroke diagnosis?
Lipid testing, coagulation testing, and ECG.
p.64
Diagnosis and Imaging Techniques for Stroke
What is the Class and Level of Evidence for using CT or MRI to distinguish ischemic stroke from ICH?
Class I, Level of Evidence A.
p.33
Types and Subtypes of Stroke
Name an ischemic syndrome associated with the internal carotid artery.
Internal carotid artery ischemic syndrome.
p.43
Diagnosis and Imaging Techniques for Stroke
What is the significance of diffusion-perfusion mismatch in stroke diagnosis?
It indicates the area of penumbra, which is the target of thrombolysis.
p.64
Diagnosis and Imaging Techniques for Stroke
Which imaging techniques can be useful to evaluate for underlying structural lesions including vascular malformations and tumors?
CT angiography, CT venography, contrast-enhanced CT, contrast-enhanced MRI, MRA, and MRV.
p.55
Management and Treatment Strategies for Acute Stroke
How often should neurological assessments be performed during and after Alteplase infusion?
Every 15 minutes during the infusion, every 30 minutes for the next 6 hours, then hourly until 24 hours after treatment.
p.1
Definition and Classification of Stroke
What is a stroke?
A stroke occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients.
p.47
Management and Treatment Strategies for Acute Stroke
Within what time frame is mechanical thrombectomy most effective?
Within 6 to 24 hours of symptom onset, depending on patient eligibility.
p.74
Management and Treatment Strategies for Acute Stroke
Why is interdisciplinary care important in the treatment of stroke patients?
Because it involves collaboration among various medical specialties to provide comprehensive care.
p.20
Risk Factors for Ischaemic Stroke
What are non-modifiable risk factors for ischemic stroke?
Age, Gender (male >45), Family history, Ethnicity, Prior TIA, Prior stroke.
p.23
Pathophysiology of Ischaemic Brain Injury
What does the phrase 'Time is Brain: Save the Penumbra' imply in the context of stroke?
It emphasizes the importance of timely intervention to save the penumbra, the zone of reversible ischemia around the core of irreversible infarction.
p.32
Types and Subtypes of Stroke
What is a crossed deficit?
A neurological condition where symptoms occur on opposite sides of the body, such as facial weakness on one side and limb weakness on the other.
p.32
Types and Subtypes of Stroke
What can cause loss of consciousness in a stroke?
Severe disruption of blood flow to the brain, particularly in the vertebrobasilar territory.
p.23
Pathophysiology of Ischaemic Brain Injury
What is the significance of a clot in an artery during an ischemic stroke?
A clot in an artery blocks blood flow, leading to ischemia and potential infarction in the brain.
p.79
Rehabilitation and Quality of Life After Stroke
What recreational activities might be beneficial for stroke survivors?
Activities such as swimming, walking, and adapted sports can help improve physical fitness, social interaction, and overall well-being.
p.75
Rehabilitation and Quality of Life After Stroke
How does stroke rehabilitation aim to support patients and their families psychologically?
By optimizing psychosocial adaptation of patients and families.
p.18
Aetiology of Ischaemic and Haemorrhagic Strokes
What conditions can cause blood vessel injury leading to thrombotic ischemic strokes?
Hypertension (HTN), atherosclerosis, and vasculitis.
p.33
Types and Subtypes of Stroke
Which artery is associated with lateral medullary syndrome?
Posterior inferior cerebellar artery.
p.43
Diagnosis and Imaging Techniques for Stroke
What does perfusion-weighted imaging (PWI) detect?
Abnormal tissue perfusion.
p.44
Diagnosis and Imaging Techniques for Stroke
What does DWI stand for in multimodal MRI imaging?
Diffusion-Weighted Imaging.
p.45
Diagnosis and Imaging Techniques for Stroke
How does the brightness of DWI change over time after a stroke?
DWI becomes more bright with a maximum at 7 days.
p.50
Secondary Prevention of Stroke
What is a high-risk strategy in stroke prevention?
A strategy that focuses on individuals at high risk, such as those with hypertension, TIA, atrial fibrillation, or other vascular diseases.
p.37
Types and Subtypes of Stroke
What is palatal palsy and which syndrome is it associated with?
Palatal palsy is a paralysis of the muscles of the palate, and it is associated with Lateral Medullary (PICA) Syndrome.
p.47
Management and Treatment Strategies for Acute Stroke
What is the primary goal of acute stroke therapy?
To restore blood flow to the affected area of the brain as quickly as possible.
p.1
Risk Factors for Ischaemic Stroke
What are common risk factors for ischaemic stroke?
High blood pressure, smoking, diabetes, high cholesterol, and atrial fibrillation.
p.22
Pathophysiology of Ischaemic Brain Injury
What is the final outcome if CBF is not restored in the affected brain tissue?
Infarction and cell death.
p.41
Diagnosis and Imaging Techniques for Stroke
What aspects of stroke does CT imaging evaluate?
Tissue status and vessel status.
p.16
Types and Subtypes of Stroke
What are the two main types of hemorrhagic stroke?
Intracerebral Hemorrhage and Subarachnoid Hemorrhage
p.32
Types and Subtypes of Stroke
What is amaurosis fugax?
A temporary loss of vision in one eye due to a lack of blood flow to the retina.
p.47
Management and Treatment Strategies for Acute Stroke
What supportive care measures are important in the management of acute stroke?
Monitoring and managing blood glucose levels, body temperature, and oxygenation.
p.32
Types and Subtypes of Stroke
What is quadraparesis?
Weakness in all four limbs.
p.63
Aetiology of Ischaemic and Haemorrhagic Strokes
What are arteriovenous malformations and how do they relate to stroke?
Arteriovenous malformations are abnormalities in blood vessels that can rupture and cause hemorrhagic stroke.
p.63
Aetiology of Ischaemic and Haemorrhagic Strokes
How does the accumulation of amyloid contribute to stroke?
Amyloid accumulation can weaken blood vessels, making them more prone to rupture and cause hemorrhagic stroke.
p.36
Pathophysiology of Ischaemic Brain Injury
What cranial nerve palsies can occur in vertebro-basilar ischemia?
Cranial nerve palsies can involve any of the cranial nerves, leading to symptoms such as facial weakness, double vision, and difficulty swallowing.
p.37
Types and Subtypes of Stroke
What are common symptoms of Lateral Medullary (PICA) Syndrome?
Vertigo and vomiting, palatal palsy, Vth sensory loss, checker board sensory loss, cerebellar signs, and Horner’s syndrome.
p.50
Secondary Prevention of Stroke
What is a mass population strategy in stroke prevention?
A strategy that targets the entire population to reduce risk factors such as hypertension and smoking.
p.58
Management and Treatment Strategies for Acute Stroke
Which medications target endothelial cell functions in stroke management?
ACE inhibitors, calcium blockers, and statins.
p.40
Aetiology of Ischaemic and Haemorrhagic Strokes
What is a cerebral infarction?
A type of stroke caused by the interruption of blood supply to a part of the brain, leading to tissue death.
p.13
Epidemiology and Global Burden of Stroke
How does the mortality rate of stroke compare to TB, Dengue, and AIDS in Sri Lanka?
Stroke causes more deaths than TB, Dengue, and AIDS combined.
p.55
Management and Treatment Strategies for Acute Stroke
How frequently should blood pressure be measured during and after Alteplase treatment?
Every 15 minutes for the first 2 hours, every 30 minutes for the next 6 hours, then hourly until 24 hours after treatment.
p.1
Types and Subtypes of Stroke
What are the two main types of stroke?
Ischaemic stroke and haemorrhagic stroke.
p.1
Aetiology of Ischaemic and Haemorrhagic Strokes
What causes an ischaemic stroke?
An ischaemic stroke is caused by a blockage in an artery that supplies blood to the brain.
p.42
Differential Diagnosis of Stroke
What post-cardiac event can be a differential diagnosis of stroke?
Post-cardiac arrest ischemia.
p.54
Management and Treatment Strategies for Acute Stroke
What medications should be avoided for 24 hours following tPA / Alteplase therapy?
Antiplatelet or antithrombotic medications.
p.69
Management and Treatment Strategies for Acute Stroke
When should early neurosurgical consultation occur for SAH patients?
Within the first 3 days of the bleed.
p.54
Management and Treatment Strategies for Acute Stroke
What level of evidence supports the use of tPA / Alteplase therapy within the 0-4.5 hours window for acute stroke?
Level 1 Class A evidence with national and international guideline and regulatory body approval.
p.20
Risk Factors for Ischaemic Stroke
Which risk factors for ischemic stroke are considered possible?
Oral contraceptive use, Infection, Stress, Prothrombotic factors, Sleep apnea.
p.23
Pathophysiology of Ischaemic Brain Injury
What is the core in the context of an ischemic stroke?
The core is the area of irreversible infarction in the brain during an ischemic stroke.
p.23
Pathophysiology of Ischaemic Brain Injury
What causes the penumbra to become damaged after an ischemic stroke?
The penumbra can be damaged by hypoperfusion, hyperglycemia, fever, and seizure.
p.34
Types and Subtypes of Stroke
What cognitive impairments are associated with a Posterior Cerebral Artery (PCA) stroke?
Memory loss/confusion, alexia.
p.36
Pathophysiology of Ischaemic Brain Injury
What are the possible states of consciousness in vertebro-basilar ischemia?
Patients may experience stupor or coma due to severe brainstem involvement.
p.79
Rehabilitation and Quality of Life After Stroke
In what ways can a stroke affect a person's employment?
A stroke can lead to physical and cognitive impairments that may limit a person's ability to perform their job or require adjustments in their work environment.
p.55
Management and Treatment Strategies for Acute Stroke
What is the dosage and administration method for Alteplase therapy?
Infuse 0.9 mg/kg (maximum dose 90 mg) over 60 minutes with 10% of the dose given as a bolus over 1 minute.
p.50
Secondary Prevention of Stroke
What is the goal of secondary prevention in stroke management?
To prevent recurrent strokes.
p.42
Differential Diagnosis of Stroke
What type of trauma can be a differential diagnosis of stroke?
Craniocerebral or cervical trauma.
p.77
Rehabilitation and Quality of Life After Stroke
What nutritional issues can stroke patients face?
Malnutrition and dehydration.
p.22
Pathophysiology of Ischaemic Brain Injury
What happens when CBF is reduced to 8 ml/100g/min?
Electrical activity failure and decreased ATP production.
p.41
Diagnosis and Imaging Techniques for Stroke
What does PCT stand for in the context of stroke imaging?
Perfusion Computed Tomography.
p.47
Diagnosis and Imaging Techniques for Stroke
What role do imaging techniques play in acute stroke therapy?
They help determine the type of stroke and the location and extent of the brain injury, guiding treatment decisions.
p.32
Types and Subtypes of Stroke
What are common symptoms of a stroke in the vertebrobasilar territory?
Hemianopia, quadraparesis, cranial nerve dysfunction, cerebellar syndrome, crossed deficit, and loss of consciousness.
p.36
Pathophysiology of Ischaemic Brain Injury
What are the bilateral long tract signs associated with vertebro-basilar ischemia?
Bilateral long tract signs refer to symptoms affecting both sides of the body due to damage in the spinal cord or brainstem pathways.
p.32
Types and Subtypes of Stroke
What is cranial nerve dysfunction?
Impairment of one or more of the cranial nerves, affecting functions such as facial movement and sensation.
p.63
Aetiology of Ischaemic and Haemorrhagic Strokes
What is an aneurysm and how does it relate to subarachnoid hemorrhage (SAH)?
An aneurysm is a weakened area in a blood vessel that can burst, leading to subarachnoid hemorrhage (SAH).
p.68
Aetiology of Ischaemic and Haemorrhagic Strokes
Why is hematoma expansion a significant concern in ICH?
It can worsen the patient's condition and increase the risk of mortality and morbidity.
p.13
Epidemiology and Global Burden of Stroke
What is the rank of stroke as a cause of hospital deaths in Sri Lanka?
Stroke is the 4th leading cause of hospital deaths.
p.78
Rehabilitation and Quality of Life After Stroke
What type of rehabilitation care is provided on an appointment basis after discharge from inpatient care?
Outpatient rehabilitation.
p.42
Differential Diagnosis of Stroke
What intracranial conditions can mimic stroke symptoms?
Intracranial mass, tumor, and subdural hematoma.
p.76
Management and Treatment Strategies for Acute Stroke
What pain syndrome can develop after a stroke?
Central post-stroke pain syndrome.
p.69
Management and Treatment Strategies for Acute Stroke
Is prophylactic hypervolemia or balloon angioplasty recommended before the development of angiographic spasm in SAH patients?
No, it is not recommended.
p.1
Management and Treatment Strategies for Acute Stroke
What is the primary goal in the management of acute stroke?
To restore blood flow to the brain as quickly as possible.
p.32
Types and Subtypes of Stroke
What are common symptoms of a stroke in the carotid territory?
Amaurosis fugax, dysphasia, hemiparesis, and hemi-sensory loss.
p.27
Aetiology of Ischaemic and Haemorrhagic Strokes
Why are vertebral arteries well protected?
Because they pass through the cervical vertebrae.
p.63
Aetiology of Ischaemic and Haemorrhagic Strokes
What is a common cause of intracerebral hemorrhage (ICH)?
High blood pressure (hypertension).
p.32
Types and Subtypes of Stroke
What is hemianopia?
Loss of half of the field of vision in one or both eyes.
p.20
Risk Factors for Ischaemic Stroke
Which risk factors for ischemic stroke are considered established?
Hypertension, Diabetes, Dyslipidaemia, AF/heart disease, Smoking, Alcohol consumption, Physical inactivity, Obesity, Dietary factors.
p.32
Types and Subtypes of Stroke
What is cerebellar syndrome?
A condition characterized by ataxia, dysmetria, and other coordination problems due to cerebellar damage.
p.34
Types and Subtypes of Stroke
What cognitive impairments are associated with an Anterior Cerebral Artery (ACA) stroke?
Muteness, perseveration, abulia, disinhibition.
p.54
Management and Treatment Strategies for Acute Stroke
Within what time frame should tPA / Alteplase therapy be initiated for acute stroke?
As soon as possible, but not greater than 4.5 hours from onset.
p.69
Management and Treatment Strategies for Acute Stroke
What medication and dosage is used to reduce secondary vasospasm in SAH patients?
Nimodipine 60 mg every 4 hours for 3 weeks.
p.47
Management and Treatment Strategies for Acute Stroke
What is the importance of maintaining optimal blood pressure in acute stroke patients?
To ensure adequate perfusion to the brain while avoiding complications from high or low blood pressure.
p.63
Aetiology of Ischaemic and Haemorrhagic Strokes
How can trauma contribute to stroke?
Trauma can cause bleeding in the brain, leading to a stroke.
p.63
Aetiology of Ischaemic and Haemorrhagic Strokes
What is the impact of blood-clotting deficiencies on stroke risk?
Blood-clotting deficiencies can lead to uncontrolled bleeding, increasing the risk of hemorrhagic stroke.
p.34
Types and Subtypes of Stroke
What cognitive impairments are associated with a Right Middle Cerebral Artery (RMCA) stroke?
Neglect, topographical difficulty, apraxia, constructional impairment.
p.36
Pathophysiology of Ischaemic Brain Injury
What is Horner’s syndrome?
Horner’s syndrome is characterized by ptosis, miosis, and anhidrosis, resulting from disruption of the sympathetic nerves supplying the eye.
p.79
Rehabilitation and Quality of Life After Stroke
How can a stroke impact a person's education?
A stroke can affect cognitive functions such as memory, attention, and problem-solving skills, which may hinder educational pursuits.
p.2
Management and Treatment Strategies for Acute Stroke
What are the consequences of delayed treatment in stroke patients?
Delayed treatment can result in more extensive brain damage, reduced chances of recovery, and higher rates of disability.
p.79
Rehabilitation and Quality of Life After Stroke
Why is family involvement important in the rehabilitation process after a stroke?
Family involvement provides emotional support, helps with daily activities, and encourages adherence to rehabilitation programs.
p.68
Management and Treatment Strategies for Acute Stroke
What are potential treatments aimed at in the context of ICH?
Preventing or limiting hematoma expansion.
p.68
Management and Treatment Strategies for Acute Stroke
How can rapid blood pressure control help in ICH?
It can reduce the risk of further bleeding and hematoma expansion.
p.2
Secondary Prevention of Stroke
What can be done to address the neglect of stroke as a medical emergency?
Increasing public awareness, improving emergency response systems, and ensuring timely access to medical care can help address the neglect of stroke.
p.2
Epidemiology and Global Burden of Stroke
Why is stroke considered a neglected medical emergency?
Because it often does not receive the immediate attention and resources it requires despite its severe impact on health.
p.2
Epidemiology and Global Burden of Stroke
What is the impact of neglecting stroke as a medical emergency?
Neglecting stroke can lead to increased mortality, long-term disability, and a higher burden on healthcare systems.
What is the aetiology of ischaemic stroke?
Ischaemic stroke is caused by a blockage in an artery that supplies blood to the brain, often due to a blood clot.
What are the key components in the management of acute stroke?
The management of acute stroke includes rapid assessment, imaging techniques like CT or MRI, thrombolytic therapy for ischaemic stroke, and surgical intervention for haemorrhagic stroke.
What is the definition of stroke?
A stroke is a medical condition where poor blood flow to the brain results in cell death.
What is the aetiology of haemorrhagic stroke?
Haemorrhagic stroke is caused by the rupture of a blood vessel in the brain, leading to bleeding within or around the brain.
What are the two main classifications of stroke?
Ischaemic stroke and haemorrhagic stroke.
What are common signs and symptoms of a stroke?
Common signs and symptoms include sudden numbness or weakness in the face, arm, or leg, especially on one side of the body, confusion, trouble speaking, difficulty understanding speech, trouble seeing in one or both eyes, difficulty walking, dizziness, loss of balance or coordination, and severe headache with no known cause.
What are some strategies for the secondary prevention of stroke?
Secondary prevention strategies include lifestyle modifications, controlling risk factors such as hypertension and diabetes, antiplatelet or anticoagulant therapy, and possibly surgical interventions like carotid endarterectomy.
