What does yellow indicate in stroke imaging?
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Diffusion.
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What does yellow indicate in stroke imaging?
Diffusion.
What are lacunar syndromes?
Lacunar syndromes are a type of stroke that occurs due to the occlusion of small penetrating arteries.
What does red indicate in stroke imaging?
Perfusion.
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 another critical objective in the management of acute stroke?
Prevent death due to cerebral/systemic effects.
What percentage of strokes are hemorrhagic strokes?
12%
What are the two main types of hemorrhagic stroke?
Intracerebral Hemorrhage and Subarachnoid Hemorrhage
What percentage of hemorrhagic strokes are intracerebral hemorrhages?
59%
What is an acute stroke unit?
A discrete area in the hospital staffed by a specialist stroke multidisciplinary team.
What is a Transient Ischemic Attack (TIA)?
An ischemic event lasting less than 24 hours without apparent permanent neurological deficits.
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 characterizes a stroke in evolution?
Progressive neurological deficits over time suggesting a widening of the area of ischemia.
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 types of underlying structural lesions can be evaluated using CTA/CTV, MRI with gadolinium, and MRA/MRV?
Vascular malformations and/or tumors.
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.
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 causes a haemorrhagic stroke?
A blood vessel in the brain bursts, leading to bleeding in or around the brain.
When should secondary prevention of stroke begin?
As early as feasible.
What regular meetings occur in an acute stroke unit?
Regular multidisciplinary team meetings for goal setting.
Which arteries form the Circle of Willis?
The internal carotid arteries and the basilar artery.
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 arteries are involved in anterior circulation ischemic strokes?
Carotid arteries.
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 some non-pharmacological interventions for managing stroke risk factors?
Lifestyle modifications such as cessation of smoking and alcohol, exercise, and weight reduction.
What arteries primarily supply the posterior circulation of the brain?
The vertebral arteries and the basilar artery.
What venous circulation condition can contribute to embolic ischemic stroke?
Patent foramen ovale (PFO) with right-to-left shunt and emboli.
What imaging technique reliably distinguishes between haemorrhagic and ischemic stroke?
CT Scan.
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 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 is one current strategy for managing stroke?
Treatment of risk factors in large populations.
What types of cardiac imaging are used in stroke diagnosis?
TTE, TEE, and heart monitoring.
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.
What does DWI 'bright-up' indicate in the context of stroke?
It indicates an acute ischemic stroke.
What lifestyle modifications can help reduce the risk of stroke?
Cessation of smoking, cessation of alcohol, exercise, and weight reduction.
What is the most sensitive sequence for stroke imaging?
Diffusion weighted images (DWI).
Which areas of the brain are supplied by the posterior circulation?
The occipital lobes, cerebellum, and brainstem.
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.
How soon after stroke onset can a CT scan detect signs of ischemia?
As early as 2 hours.
What is a leading cause of death in the world?
Stroke.
Which cerebral artery ischemic syndrome can be classified as proximal or distal?
Middle cerebral and Anterior cerebral.
Which artery is part of the anterior circulation of the brain?
The internal carotid artery.
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 surgical procedure is recommended for eligible patients to prevent secondary stroke?
Carotid endarterectomy.
What percentage of stroke rehabilitation patients achieve independent mobility?
80%
What tests are included in lipid and coagulation testing for stroke diagnosis?
Lipid testing, coagulation testing, and ECG.
What conditions can cause blood vessel injury leading to thrombotic ischemic strokes?
Hypertension (HTN), atherosclerosis, and vasculitis.
Which arteries branch off from the Circle of Willis to supply the brain?
The anterior cerebral arteries, middle cerebral arteries, and posterior cerebral arteries.
What are some pharmacological interventions for managing stroke risk factors?
Management of diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, cardiac diseases, and symptomatic carotid stenosis.
Which types of infarcts can be detected using DWI?
Posterior circulation infarct, Anterior circulation infarct, and MCA infarct.
What is recommended for distinguishing ischemic stroke from ICH?
Rapid neuroimaging with CT or MRI.
How does DWI help in stroke diagnosis besides detecting acute ischemic stroke?
It helps in differentiating between new and old lesions.
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 sudden cognitive changes can indicate a stroke?
Sudden confusion, trouble speaking, or understanding.
What can a CT scan identify immediately in the context of stroke?
Haemorrhage.
Which artery is associated with lateral medullary syndrome?
Posterior inferior cerebellar artery.
What lifestyle changes are recommended for secondary stroke prevention?
Lifestyle modification.
What is a key component in the management of acute stroke?
Immediate medical intervention and treatment.
What percentage of stroke rehabilitation patients achieve independent personal care?
70%
What are the prevention strategies for stroke management?
Endarterectomy and stenting.
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).
What factors contribute to stasis or turbulent blood flow in thrombotic ischemic strokes?
Atherosclerosis, atrial fibrillation (A. fib.), and valve disorders.
What are some key strategies for preventing a first stroke?
Managing blood pressure, controlling glucose levels, quitting smoking, and managing lipid levels.
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 does perfusion-weighted imaging (PWI) detect?
Abnormal tissue perfusion.
When does DWI become positive in the case of brain infarction?
DWI is already positive in the acute phase.
What are the main branches of the basilar artery?
The posterior cerebral arteries, superior cerebellar arteries, and anterior inferior cerebellar arteries.
What percentage of strokes are ischemic?
88%
How often does someone die of a stroke in the world?
Every six seconds.
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.
In what percentage of cases can a CT scan detect acute subarachnoid hemorrhage (SAH)?
95%.
What does DWI stand for in multimodal MRI imaging?
Diffusion-Weighted Imaging.
What health parameters should be optimized for secondary stroke prevention?
Blood glucose, cholesterol, and blood pressure.
What is important for the prevention and treatment of medical and neurological complications in stroke patients?
Comprehensive medical care and monitoring.
What percentage of stroke rehabilitation patients are able to go outside their home?
40%
What are the acute management options for stroke?
Thrombolytics – both medical and mechanical.
What is the primary cause of a stroke as per the WHO definition?
Vascular origin.
What is the invasive vascular imaging technique used for stroke diagnosis?
Conventional cerebral angiography.
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 is a mass population strategy in stroke prevention?
A strategy that targets the entire population to reduce risk factors such as hypertension and smoking.
What is the first level of rehabilitation care?
Therapy during acute care.
What is the significance of diffusion-perfusion mismatch in stroke diagnosis?
It indicates the area of penumbra, which is the target of thrombolysis.
How does the brightness of DWI change over time after a stroke?
DWI becomes more bright with a maximum at 7 days.
What imaging techniques may be considered to help identify patients at risk for hematoma expansion?
CT angiography and contrast-enhanced CT.
What is the second leading cause of death worldwide?
Stroke, causing 5 million deaths each year.
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 are some sudden motor coordination issues that can indicate a stroke?
Sudden trouble walking, dizziness/vertigo, loss of balance or coordination.
What percentage of ischemic strokes are due to atherothrombotic or large vessel cerebrovascular disease?
20%
Besides stroke, what other neurological diseases can a CT scan help identify?
Neoplasms.
Which syndrome is characterized by vertigo and vomiting?
Lateral Medullary (PICA) Syndrome.
What does PWI stand for in multimodal MRI imaging?
Perfusion-Weighted Imaging.
What role does rehabilitation play in stroke management?
It helps in the recovery and improvement of quality of life after a stroke.
What percentage of stroke rehabilitation patients are able to return to work?
30%
Which medications target endothelial cell functions in stroke management?
ACE inhibitors, calcium blockers, and statins.
What effect does anticoagulation have on intracerebral hemorrhage (ICH)?
Anticoagulation leads to more hematoma growth and higher mortality.
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 follows therapy during acute care in the levels of rehabilitation care?
Acute comprehensive inpatient rehabilitation.
For how long will DWI remain positive after the onset of brain infarction?
Approximately for 3 weeks.
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 type of headache is a warning sign of a hemorrhagic stroke?
Sudden, severe headaches with no known cause.
What percentage of ischemic strokes are cardio-embolic?
20%
What is the 2nd leading cause of death after 60 years of age?
Stroke.
What is the prevalence of stroke in Colombo, Sri Lanka?
1% (1 in 100 people).
What does MRA stand for in multimodal MRI imaging?
Magnetic Resonance Angiography.
What is a strategy to prevent recurrent strokes?
Implementing secondary prevention measures.
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 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 a cerebral infarction?
A type of stroke caused by the interruption of blood supply to a part of the brain, leading to tissue death.
What are some common bladder-related complications of stroke?
Bladder dysfunction.
What should be done promptly and aggressively in patients with ICH on warfarin?
Reverse warfarin.
How can stroke mortality be reduced?
Through acute treatment and effective secondary prevention strategies.
What percentage of the human body's mass does the brain constitute?
2%
What is the third level of rehabilitation care?
Sub acute comprehensive inpatient rehabilitation.
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.
Which respiratory condition is a frequent complication after a stroke?
Pneumonia.
What percentage of ischemic strokes are lacunar?
25%
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 are cerebellar signs in the context of Lateral Medullary (PICA) Syndrome?
Symptoms indicating cerebellar dysfunction, such as ataxia or coordination problems.
What is the purpose of Diffusion-Weighted Imaging (DWI) in MRI?
To assess tissue status.
What are the two main types of stroke?
Ischemic stroke and hemorrhagic stroke.
What is the normal cerebral blood flow (CBF) in ml/100g/min?
50 – 55 ml/100g/min
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.
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 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 are two options for reversing warfarin in patients with ICH?
Fresh frozen plasma (FFP) or prothrombin complex concentrates.
What bowel-related issue can arise as a complication of stroke?
Bowel dysfunction.
What is the goal of secondary prevention in stroke management?
To prevent recurrent strokes.
What percentage of cardiac output does the brain receive?
20%
What type of rehabilitation care involves intensive therapy but allows patients to return home each day?
Comprehensive day rehabilitation.
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 swallowing disorder can occur as a complication of stroke?
Dysphagia.
What is the leading cause of adult disability?
Stroke.
What is another term for lacunar strokes?
Small vessel disease
What is the rank of stroke as a cause of hospital deaths in Sri Lanka?
Stroke is the 4th leading cause of hospital deaths.
Which syndrome includes Horner’s syndrome as a symptom?
Lateral Medullary (PICA) Syndrome.
What is the purpose of Perfusion-Weighted Imaging (PWI) in MRI?
To assess perfusion status.
What type of trauma can be a differential diagnosis of stroke?
Craniocerebral or cervical trauma.
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 happens to brain tissue when CBF is reduced to 25 ml/100g/min?
Ischemia occurs.
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 type of skin condition is a common complication of stroke?
Pressure ulcers.
What intravenous treatment can be used to reverse warfarin in ICH patients?
IV vitamin K.
How can stroke-related disability be reduced?
Through rehabilitation and effective management of risk factors.
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 type of rehabilitation care is provided on an appointment basis after discharge from inpatient care?
Outpatient rehabilitation.
What type of dysfunction related to breathing can be a complication of stroke?
Ventilatory dysfunction.
What percentage of ischemic strokes are cryptogenic or due to other known causes?
35%
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 purpose of Magnetic Resonance Angiography (MRA) in MRI?
To assess vessel status.
Which infections can be considered in the differential diagnosis of stroke?
Meningitis and encephalitis.
What are the target blood pressure levels to maintain during Alteplase therapy?
SBP < 180 and DBP < 105.
What is the effect of CBF reduction to 20 ml/100g/min?
Edema develops.
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 is a potential risk associated with IV vitamin K administration?
A small risk of anaphylactoid reaction.
What nutritional issues can stroke patients face?
Malnutrition and dehydration.
What are the two main types of stroke?
Ischaemic stroke and haemorrhagic stroke.
What is the final level of rehabilitation care that allows patients to receive therapy in their own homes?
Home rehabilitation.
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 type of environment should a patient with SAH be nursed in?
Quiet, darkened surroundings.
What intracranial conditions can mimic stroke symptoms?
Intracranial mass, tumor, and subdural hematoma.
What procedures should be delayed during Alteplase therapy?
Placement of nasogastric tubes, indwelling bladder catheters, or intraarterial pressure catheters.
What occurs when CBF drops to 15 ml/100g/min?
Loss of Na/K+ pump function.
What mental health condition is commonly associated with stroke?
Depression.
What causes an ischaemic stroke?
An ischaemic stroke is caused by a blockage in an artery that supplies blood to the brain.
What key pathologic event is associated with ischemic brain injury?
Decrement in regional cerebral blood flow (CBF)
What is the time window for administering intravenous thrombolysis in acute ischemic stroke?
Within 4.5 hours of symptom onset.
Which medical specialist is primarily responsible for the treatment of stroke?
Stroke physician/neurologist.
What is recommended for pain management in SAH patients?
Adequate analgesia.
What is the only proven (approved) acute stroke therapy?
tPA / Alteplase therapy.
What neurological conditions can present with persistent neurological signs similar to stroke?
Seizure and migraine.
What does multimodal CT imaging assess in stroke patients?
Perfusion status, tissue status, and vessel status.
What happens when CBF is reduced to 8 ml/100g/min?
Electrical activity failure and decreased ATP production.
What physical risks are increased in stroke patients?
Falls and injuries.
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 medication is commonly used for intravenous thrombolysis in acute ischemic stroke?
Alteplase (tPA).
Which specialist focuses on the recovery and rehabilitation of stroke patients?
Rehabilitation specialist.
What type of IV fluids should be administered to maintain euvolemia in SAH patients?
Normal Saline (N/S).
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 metabolic conditions can be mistaken for a stroke?
Hyperglycemia (nonketotic hyperosmolar coma) and hypoglycemia.
What does PCT stand for in the context of stroke imaging?
Perfusion Computed Tomography.
What is the term for the area of the brain that is at risk but not yet infarcted during reduced CBF?
Penumbra.
What type of pain and dysfunction is common in stroke patients?
Shoulder pain and dysfunction.
