What is the definition of a stroke according to the WHO?
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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.
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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.
What are lacunar syndromes?
Lacunar syndromes are a type of stroke that occurs due to the occlusion of small penetrating arteries.
What are the two main types of hemorrhagic stroke?
Intracerebral Hemorrhage and Subarachnoid Hemorrhage
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.
What causes a haemorrhagic stroke?
A blood vessel in the brain bursts, leading to bleeding in or around the brain.
What does red indicate in stroke imaging?
Perfusion.
What is a Transient Ischemic Attack (TIA)?
An ischemic event lasting less than 24 hours without apparent permanent neurological deficits.
Which arteries form the Circle of Willis?
The internal carotid arteries and the basilar artery.
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).
What is the most sensitive sequence for stroke imaging?
Diffusion weighted images (DWI).
What surgical procedure is recommended for eligible patients to prevent secondary stroke?
Carotid endarterectomy.
What sudden cognitive changes can indicate a stroke?
Sudden confusion, trouble speaking, or understanding.
What factors contribute to stasis or turbulent blood flow in thrombotic ischemic strokes?
Atherosclerosis, atrial fibrillation (A. fib.), and valve disorders.
What percentage of hemorrhagic strokes are intracerebral hemorrhages?
59%
What types of underlying structural lesions can be evaluated using CTA/CTV, MRI with gadolinium, and MRA/MRV?
Vascular malformations and/or tumors.
When should secondary prevention of stroke begin?
As early as feasible.
What arteries are involved in anterior circulation ischemic strokes?
Carotid arteries.
What imaging technique reliably distinguishes between haemorrhagic and ischemic stroke?
CT Scan.
What does DWI 'bright-up' indicate in the context of stroke?
It indicates an acute ischemic stroke.
How does DWI help in stroke diagnosis besides detecting acute ischemic stroke?
It helps in differentiating between new and old lesions.
What are the prevention strategies for stroke management?
Endarterectomy and stenting.
What is the primary cause of a stroke as per the WHO definition?
Vascular origin.
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.
What percentage of stroke rehabilitation patients are able to return to work?
30%
What does yellow indicate in stroke imaging?
Diffusion.
What percentage of strokes are hemorrhagic strokes?
12%
How can ischemic strokes be classified by vascular territory?
Ischemic strokes can be classified into anterior circulation (carotid arteries) and posterior circulation (vertebrobasilar system).
What arteries primarily supply the posterior circulation of the brain?
The vertebral arteries and the basilar artery.
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.
Which artery is part of the anterior circulation of the brain?
The internal carotid artery.
Which types of infarcts can be detected using DWI?
Posterior circulation infarct, Anterior circulation infarct, and MCA infarct.
What lifestyle changes are recommended for secondary stroke prevention?
Lifestyle modification.
What is important for the prevention and treatment of medical and neurological complications in stroke patients?
Comprehensive medical care and monitoring.
For how long will DWI remain positive after the onset of brain infarction?
Approximately for 3 weeks.
What does MRA stand for in multimodal MRI imaging?
Magnetic Resonance Angiography.
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.
What is another critical objective in the management of acute stroke?
Prevent death due to cerebral/systemic effects.
What characterizes a stroke in evolution?
Progressive neurological deficits over time suggesting a widening of the area of ischemia.
What are some non-pharmacological interventions for managing stroke risk factors?
Lifestyle modifications such as cessation of smoking and alcohol, exercise, and weight reduction.
What types of cardiac imaging are used in stroke diagnosis?
TTE, TEE, and heart monitoring.
Which cerebral artery ischemic syndrome can be classified as proximal or distal?
Middle cerebral and Anterior cerebral.
What are some pharmacological interventions for managing stroke risk factors?
Management of diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, cardiac diseases, and symptomatic carotid stenosis.
What is a key component in the management of acute stroke?
Immediate medical intervention and treatment.
What are the main branches of the basilar artery?
The posterior cerebral arteries, superior cerebellar arteries, and anterior inferior cerebellar arteries.
What percentage of stroke rehabilitation patients are able to go outside their home?
40%
What does PWI stand for in multimodal MRI imaging?
Perfusion-Weighted Imaging.
What is a strategy to prevent recurrent strokes?
Implementing secondary prevention measures.
Which respiratory condition is a frequent complication after a stroke?
Pneumonia.
What are two options for reversing warfarin in patients with ICH?
Fresh frozen plasma (FFP) or prothrombin complex concentrates.
Which syndrome includes Horner’s syndrome as a symptom?
Lateral Medullary (PICA) Syndrome.
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.
What procedures should be delayed during Alteplase therapy?
Placement of nasogastric tubes, indwelling bladder catheters, or intraarterial pressure catheters.
What neurological conditions can present with persistent neurological signs similar to stroke?
Seizure and migraine.
What is available for stroke survivors to aid in their recovery?
Support, resources, and rehabilitation.
What causes lacunar syndromes?
Lacunar syndromes are caused by the occlusion of small vessels in the brain.
What is one of the primary goals in the management of acute stroke?
Minimise neuronal damage.
What does blue indicate in stroke imaging?
Mismatch, which is the penumbra.
What can provide hope for stroke survivors?
Support, resources, and rehabilitation.
What is an acute stroke unit?
A discrete area in the hospital staffed by a specialist stroke multidisciplinary team.
What does the SPOT sign indicate in a CTA scan?
CT contrast extravasates into the hematoma.
What imaging techniques can be used to evaluate underlying structural lesions?
CTA/CTV, MRI with gadolinium, MRA/MRV.
What percentage of hemorrhagic strokes are subarachnoid hemorrhages?
41%
What are the two major types of stroke?
Ischaemic stroke and haemorrhagic stroke.
What causes an ischaemic stroke?
A blockage in an artery that supplies blood to the brain.
What is the Circle of Willis?
A circular network of arteries located at the base of the brain.
What are some heart-related causes of embolic ischemic stroke?
Valve diseases, atrial fibrillation, dilated cardiomyopathy, and myxoma.
What can the presence of a SPOT sign predict?
It may predict hematoma expansion.
How is the concept 'Time is brain' quantified in stroke treatment?
Every minute a stroke goes untreated, approximately 1.9 million neurons are lost.
What regular meetings occur in an acute stroke unit?
Regular multidisciplinary team meetings for goal setting.
What arterial circulation issues can lead to embolic ischemic stroke?
Atherosclerosis of the carotid artery, arterial dissection, and vasculitis.
From where does the internal carotid artery arise?
From the common carotid artery.
What is a completed stroke?
An ischemic event with a persisted deficit.
What are the primary brain imaging techniques used for stroke diagnosis?
CT and MR.
What type of therapy is recommended for secondary prevention of stroke?
Anti-platelet therapy.
What is the primary function of the Circle of Willis?
To provide collateral blood flow to the brain in case of arterial blockage.
What imaging technique is used to detect areas of restricted diffusion of water in acute ischemic stroke?
Diffusion-weighted imaging (DWI).
What are the branches of the internal carotid artery?
Anterior cerebral, anterior communicating, middle cerebral, and posterior communicating arteries.
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.
What system is involved in posterior circulation ischemic strokes?
Vertebrobasilar (VB) system.
What medication is recommended for cardioembolic strokes?
Anti-coagulants.
What venous circulation condition can contribute to embolic ischemic stroke?
Patent foramen ovale (PFO) with right-to-left shunt and emboli.
What is recommended for distinguishing ischemic stroke from ICH?
Rapid neuroimaging with CT or MRI.
What percentage of stroke rehabilitation patients achieve independent personal care?
70%
What percentage of strokes are ischemic?
88%
What are the acute management options for stroke?
Thrombolytics – both medical and mechanical.
What is the second leading cause of death worldwide?
Stroke, causing 5 million deaths each year.
What role does rehabilitation play in stroke management?
It helps in the recovery and improvement of quality of life after a 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.
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.
What percentage of ischemic strokes are lacunar?
25%
What bowel-related issue can arise as a complication of stroke?
Bowel dysfunction.
What is the purpose of Perfusion-Weighted Imaging (PWI) in MRI?
To assess perfusion status.
What is a potential risk associated with IV vitamin K administration?
A small risk of anaphylactoid reaction.
What occurs when CBF drops to 15 ml/100g/min?
Loss of Na/K+ pump function.
What does multimodal CT imaging assess in stroke patients?
Perfusion status, tissue status, and vessel status.
What metabolic conditions can be mistaken for a stroke?
Hyperglycemia (nonketotic hyperosmolar coma) and hypoglycemia.
What should be monitored and treated if present during tPA / Alteplase therapy, especially if the patient is on ACE inhibitors?
Angioedema.
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.
What are some strategies for secondary prevention of stroke?
Lifestyle changes, medications to control risk factors, and surgical interventions if necessary.
What is hemi-sensory loss?
Loss of sensation on one side of the body.
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.
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.
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.
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.
What is one current strategy for managing stroke?
Treatment of risk factors in large populations.
What is a leading cause of death in the world?
Stroke.
Which arteries branch off from the Circle of Willis to supply the brain?
The anterior cerebral arteries, middle cerebral arteries, and posterior cerebral arteries.
When does DWI become positive in the case of brain infarction?
DWI is already positive in the acute phase.
What health parameters should be optimized for secondary stroke prevention?
Blood glucose, cholesterol, and blood pressure.
What imaging techniques may be considered to help identify patients at risk for hematoma expansion?
CT angiography and contrast-enhanced CT.
Which syndrome is characterized by vertigo and vomiting?
Lateral Medullary (PICA) Syndrome.
What follows therapy during acute care in the levels of rehabilitation care?
Acute comprehensive inpatient rehabilitation.
What is the third level of rehabilitation care?
Sub acute comprehensive inpatient rehabilitation.
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.
What is the leading cause of adult disability?
Stroke.
How can stroke-related disability be reduced?
Through rehabilitation and effective management of risk factors.
Which infections can be considered in the differential diagnosis of stroke?
Meningitis and encephalitis.
What type of environment should a patient with SAH be nursed in?
Quiet, darkened surroundings.
What is recommended for pain management in SAH patients?
Adequate analgesia.
Which specialist focuses on the recovery and rehabilitation of stroke patients?
Rehabilitation specialist.
What imaging techniques are commonly used to diagnose a stroke?
CT scan and MRI.
What arteries are responsible for the posterior circulation of the brain?
Vertebral arteries.
Why is rehabilitation important after a stroke?
Rehabilitation helps stroke survivors regain as much independence and quality of life as possible.
What is hemiparesis?
Weakness on one side of the body.
What type of weakness is associated with a Middle Cerebral Artery (MCA) stroke?
Arm>leg weakness.
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.
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.
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.
What lifestyle modifications can help reduce the risk of stroke?
Cessation of smoking, cessation of alcohol, exercise, and weight reduction.
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.
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).
How often does someone die of a stroke in the world?
Every six seconds.
What is the invasive vascular imaging technique used for stroke diagnosis?
Conventional cerebral angiography.
What are some sudden motor coordination issues that can indicate a stroke?
Sudden trouble walking, dizziness/vertigo, loss of balance or coordination.
What type of headache is a warning sign of a hemorrhagic stroke?
Sudden, severe headaches with no known cause.
What are some common bladder-related complications of stroke?
Bladder dysfunction.
What are cerebellar signs in the context of Lateral Medullary (PICA) Syndrome?
Symptoms indicating cerebellar dysfunction, such as ataxia or coordination problems.
What type of rehabilitation care involves intensive therapy but allows patients to return home each day?
Comprehensive day rehabilitation.
What happens to brain tissue when CBF is reduced to 25 ml/100g/min?
Ischemia occurs.
What percentage of ischemic strokes are cryptogenic or due to other known causes?
35%
What is the final level of rehabilitation care that allows patients to receive therapy in their own homes?
Home rehabilitation.
What key pathologic event is associated with ischemic brain injury?
Decrement in regional cerebral blood flow (CBF)
What type of pain and dysfunction is common in stroke patients?
Shoulder pain and dysfunction.
What does CTA stand for in stroke imaging?
Computed Tomography Angiography.
What substance-related condition can mimic stroke symptoms?
Drug or narcotic overdose.
What diagnostic procedure should be performed 24 hours after tPA / Alteplase therapy before starting antiplatelet or antithrombotic medications?
A brain scan.
What is dysphasia?
A language disorder marked by impaired ability to communicate.
How can tumors cause strokes?
Tumors can press on blood vessels or cause bleeding, leading to a stroke.
What is checkerboard anesthesia?
Checkerboard anesthesia is a pattern of sensory loss where alternating areas of the body lose sensation.
What are cerebellar signs in vertebro-basilar ischemia?
Cerebellar signs include symptoms such as ataxia, dysmetria, and intention tremor, indicating cerebellar dysfunction.
What are some quality of life issues that can be affected after a stroke?
Sexuality, spirituality, driving, employment, education, recreation, and family involvement.
What are dysconjugate eye movements?
Dysconjugate eye movements occur when the eyes do not move together in a coordinated manner.
How can a stroke impact a person's ability to drive?
A stroke can affect physical and cognitive abilities, which may impair driving skills.
Which areas of the brain are supplied by the posterior circulation?
The occipital lobes, cerebellum, and brainstem.
What are some key strategies for preventing a first stroke?
Managing blood pressure, controlling glucose levels, quitting smoking, and managing lipid levels.
In what percentage of cases can a CT scan detect acute subarachnoid hemorrhage (SAH)?
95%.
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.
What percentage of ischemic strokes are cardio-embolic?
20%
What should be done promptly and aggressively in patients with ICH on warfarin?
Reverse warfarin.
What is the purpose of Diffusion-Weighted Imaging (DWI) in MRI?
To assess tissue status.
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.
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.
What is the time window for administering intravenous thrombolysis in acute ischemic stroke?
Within 4.5 hours of symptom onset.
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.
What is a common issue with carotid arteries?
They are frequently congested with plaque.
What is a serious risk for stroke survivors?
Recurrent strokes.
What percentage of strokes are hemorrhagic strokes?
12%
What percentage of hemorrhagic strokes are intracerebral hemorrhages?
59%
Why are vertebral arteries not accessible for surgical cleaning?
Because they are well protected and pass through the cervical vertebrae.
What role do infections play in causing strokes?
Infections can lead to inflammation and damage to blood vessels, increasing the risk of stroke.
What cognitive impairment is associated with a Left Middle Cerebral Artery (LMCA) stroke?
Aphasia.
What type of weakness is associated with an Anterior Cerebral Artery (ACA) stroke?
Leg>arm weakness, grasp.
Name one potential treatment strategy for managing hematoma expansion in ICH.
Rapid blood pressure control.
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.
What percentage of stroke rehabilitation patients achieve independent mobility?
80%
What is the first level of rehabilitation care?
Therapy during acute care.
What percentage of ischemic strokes are due to atherothrombotic or large vessel cerebrovascular disease?
20%
What effect does anticoagulation have on intracerebral hemorrhage (ICH)?
Anticoagulation leads to more hematoma growth and higher mortality.
How can stroke mortality be reduced?
Through acute treatment and effective secondary prevention strategies.
What are the two main types of stroke?
Ischemic stroke and hemorrhagic stroke.
What type of skin condition is a common complication of stroke?
Pressure ulcers.
What is the purpose of Magnetic Resonance Angiography (MRA) in MRI?
To assess vessel status.
Which medical specialist is primarily responsible for the treatment of stroke?
Stroke physician/neurologist.
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.
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.
How soon after stroke onset can a CT scan detect signs of ischemia?
As early as 2 hours.
What tests are included in lipid and coagulation testing for stroke diagnosis?
Lipid testing, coagulation testing, and ECG.
What can a CT scan identify immediately in the context of stroke?
Haemorrhage.
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.
What is the significance of diffusion-perfusion mismatch in stroke diagnosis?
It indicates the area of penumbra, which is the target of thrombolysis.
What is the prevalence of stroke in Colombo, Sri Lanka?
1% (1 in 100 people).
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.
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.
What is another term for lacunar strokes?
Small vessel disease
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.
What are the target blood pressure levels to maintain during Alteplase therapy?
SBP < 180 and DBP < 105.
What type of IV fluids should be administered to maintain euvolemia in SAH patients?
Normal Saline (N/S).
Which medical field deals with the health care of elderly patients, including those who have had a stroke?
Geriatrics.
Within what time frame is mechanical thrombectomy most effective?
Within 6 to 24 hours of symptom onset, depending on patient eligibility.
What percentage of hemorrhagic strokes are subarachnoid hemorrhages?
41%
What are non-modifiable risk factors for ischemic stroke?
Age, Gender (male >45), Family history, Ethnicity, Prior TIA, Prior 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.
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.
What conditions can cause blood vessel injury leading to thrombotic ischemic strokes?
Hypertension (HTN), atherosclerosis, and vasculitis.
Which artery is associated with lateral medullary syndrome?
Posterior inferior cerebellar artery.
What does perfusion-weighted imaging (PWI) detect?
Abnormal tissue perfusion.
What does DWI stand for in multimodal MRI imaging?
Diffusion-Weighted Imaging.
How does the brightness of DWI change over time after a stroke?
DWI becomes more bright with a maximum at 7 days.
Besides stroke, what other neurological diseases can a CT scan help identify?
Neoplasms.
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.
What is the 2nd leading cause of death after 60 years of age?
Stroke.
What percentage of the human body's mass does the brain constitute?
2%
What is the normal cerebral blood flow (CBF) in ml/100g/min?
50 – 55 ml/100g/min
What swallowing disorder can occur as a complication of stroke?
Dysphagia.
What intravenous treatment can be used to reverse warfarin in ICH patients?
IV vitamin K.
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.
What is the primary goal of acute stroke therapy?
To restore blood flow to the affected area of the brain as quickly as possible.
What medication is commonly used for intravenous thrombolysis in acute ischemic stroke?
Alteplase (tPA).
What are common risk factors for ischaemic stroke?
High blood pressure, smoking, diabetes, high cholesterol, and atrial fibrillation.
What is the final outcome if CBF is not restored in the affected brain tissue?
Infarction and cell death.
What are the two main types of hemorrhagic stroke?
Intracerebral Hemorrhage and Subarachnoid Hemorrhage
What is amaurosis fugax?
A temporary loss of vision in one eye due to a lack of blood flow to the retina.
What supportive care measures are important in the management of acute stroke?
Monitoring and managing blood glucose levels, body temperature, and oxygenation.
What is quadraparesis?
Weakness in all four limbs.
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.
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.
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.
What motor impairment is associated with a cerebellar stroke?
Ipsilateral ataxia.
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.
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.
Which medications target endothelial cell functions in stroke management?
ACE inhibitors, calcium blockers, and statins.
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.
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.
What percentage of cardiac output does the brain receive?
20%
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.
What type of dysfunction related to breathing can be a complication of stroke?
Ventilatory dysfunction.
What are the two main types of stroke?
Ischaemic stroke and haemorrhagic stroke.
What causes an ischaemic stroke?
An ischaemic stroke is caused by a blockage in an artery that supplies blood to the brain.
What physical risks are increased in stroke patients?
Falls and injuries.
What is the term for the area of the brain that is at risk but not yet infarcted during reduced CBF?
Penumbra.
What post-cardiac event can be a differential diagnosis of stroke?
Post-cardiac arrest ischemia.
What medications should be avoided for 24 hours following tPA / Alteplase therapy?
Antiplatelet or antithrombotic medications.
When should early neurosurgical consultation occur for SAH patients?
Within the first 3 days of the bleed.
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.
Which risk factors for ischemic stroke are considered possible?
Oral contraceptive use, Infection, Stress, Prothrombotic factors, Sleep apnea.
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.
What causes the penumbra to become damaged after an ischemic stroke?
The penumbra can be damaged by hypoperfusion, hyperglycemia, fever, and seizure.
What visual impairment is associated with a Posterior Cerebral Artery (PCA) stroke?
Hemianopia.
What cognitive impairments are associated with a Posterior Cerebral Artery (PCA) stroke?
Memory loss/confusion, alexia.
What are the possible states of consciousness in vertebro-basilar ischemia?
Patients may experience stupor or coma due to severe brainstem involvement.
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.
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.
What is the goal of secondary prevention in stroke management?
To prevent recurrent strokes.
What type of trauma can be a differential diagnosis of stroke?
Craniocerebral or cervical trauma.
What nutritional issues can stroke patients face?
Malnutrition and dehydration.
What mental health condition is commonly associated with stroke?
Depression.
What happens when CBF is reduced to 8 ml/100g/min?
Electrical activity failure and decreased ATP production.
What does PCT stand for in the context of stroke imaging?
Perfusion Computed Tomography.
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.
What are common symptoms of a stroke in the vertebrobasilar territory?
Hemianopia, quadraparesis, cranial nerve dysfunction, cerebellar syndrome, crossed deficit, and loss of consciousness.
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.
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).
Why is hematoma expansion a significant concern in ICH?
It can worsen the patient's condition and increase the risk of mortality and morbidity.
What is the rank of stroke as a cause of hospital deaths in Sri Lanka?
Stroke is the 4th leading cause of hospital deaths.
What type of rehabilitation care is provided on an appointment basis after discharge from inpatient care?
Outpatient rehabilitation.
What is the effect of CBF reduction to 20 ml/100g/min?
Edema develops.
What intracranial conditions can mimic stroke symptoms?
Intracranial mass, tumor, and subdural hematoma.
What is the only proven (approved) acute stroke therapy?
tPA / Alteplase therapy.
Is prophylactic hypervolemia or balloon angioplasty recommended before the development of angiographic spasm in SAH patients?
No, it is not recommended.
What is the primary goal in the management of acute stroke?
To restore blood flow to the brain as quickly as possible.
What are common symptoms of a stroke in the carotid territory?
Amaurosis fugax, dysphasia, hemiparesis, and hemi-sensory loss.
Why are vertebral arteries well protected?
Because they pass through the cervical vertebrae.
What is a common cause of intracerebral hemorrhage (ICH)?
High blood pressure (hypertension).
What is hemianopia?
Loss of half of the field of vision in one or both eyes.
Which risk factors for ischemic stroke are considered established?
Hypertension, Diabetes, Dyslipidaemia, AF/heart disease, Smoking, Alcohol consumption, Physical inactivity, Obesity, Dietary factors.
What is cerebellar syndrome?
A condition characterized by ataxia, dysmetria, and other coordination problems due to cerebellar damage.
What cognitive impairments are associated with an Anterior Cerebral Artery (ACA) stroke?
Muteness, perseveration, abulia, disinhibition.
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.
What medication and dosage is used to reduce secondary vasospasm in SAH patients?
Nimodipine 60 mg every 4 hours for 3 weeks.
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.
How can trauma contribute to stroke?
Trauma can cause bleeding in the brain, leading to a stroke.
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.
What cognitive impairments are associated with a Right Middle Cerebral Artery (RMCA) stroke?
Neglect, topographical difficulty, apraxia, constructional impairment.
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.
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.
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.
What is a major problem associated with Intracerebral Hemorrhage (ICH)?
Hematoma expansion.
How can rapid blood pressure control help in ICH?
It can reduce the risk of further bleeding and hematoma expansion.
