Neuro- Stroke

More women die from stroke than men. True or false? A. True B. False

The correct answer is A. True Stroke is the 3rd leading cause of death for women. Women tend to live longer than men, putting them at risk for several factors that can make a stroke more deadly. Women are more likely to live alone when they have a stroke, be more likely to live in a long-term health care facility after a stroke, and to have a worse recovery following a stroke.

_______________ and stroke can occur together, or in very close proximity. A. Kidney failure B. Infection C. Heart arrhythmias D. Seizure

The correct answer is C. Heart arrhythmias Patients with new onset arrhythmias of the heart (abnormal heartbeat), especially atrial fibrillation, are at higher risk for having a stroke. Patients may not know they are in atrial fibrillation (A-Fib) and they develop blood clots that develop in the heart and travel to the brain, causing a stroke.

Complications?

Chest infection (aspiration pneumonia), Epileptic seizure, DVT, Pressure sores, UTI, Constipation, Depression & Anxiety

Classification of Ischemic Stroke based on Etiology and Clinical Localization?

TOAST & OXFORDSHIRE

What acronym can help you identify a stroke? A. SLOW B. FAST C. STROKE D. SLEEP

The correct answer is B. FAST F- Face drooping A- Arm weakness S- Speech difficulty T- Time

Strokes rarely occur in people under 65. A. True B. False

The correct answer is B. False While approximately two-thirds of strokes happen in people over age 65, people under age 65 can still have a stroke. Stroke risk does increase with age, but anyone at any age can have a stroke.

Which of the following subtypes of acute ischemic stroke is most commonly associated with hemorrhagic transformation of ischemic stroke? A. Large artery B. Small artery C. Cardioembolic infarction D. All of the above

The correct answer is C. Cardioembolic infarction Hemorrhagic transformation represents the conversion of an ischemic infarction into an area of hemorrhage. This is estimated to occur in 5% of uncomplicated ischemic strokes, in the absence of fibrinolytic treatment. Hemorrhagic transformation of an ischemic infarct occurs within 2-14 days post-ictus, usually within the first week. It is more commonly seen following cardioembolic strokes and is more likely to occur with larger infarct volumes.

Management

Acute Mx 1. ABC 2. If presented within 4.5 hrs of onset, thrombolyse with tPA (IV alteplase), if more than 4.5 hrs, run MRA to see the vessel, if there is total occlusion, refer for thrombectomy (up to 24hrs) 3. Start with Aspirin once hemorrhagic stroke is excluded 4. , Supportive therapy, Secondary Prevention

Other investigations???

Blood test 1. FBC- Hb- polycythemia, Plt- thrombocytosis (arterial occlusion, thrombocytopenia (hemorrhage) 2. Renal profile- underlying CKD 3. LFT- baseline before start statin 4. Lipid profile 5. Coagulation profile- TRO hemophilia & coagulopathy (increased aPTT with normal PT in APLS 6. TFT- to exclude hyperthyroidism (can cause AF) 7. Fasting blood glucose- TRO hypoglycemia Imaging 1. Non contrast CT- to exclude hemorrhage, SOL (infarction- hypodensity, hemorrhage- hyperdensity) 2. Carotid doppler- look for carotid stenosis 3. ECG- to exclude AF (absent of P wave, irregularly irregular rhythm, ACS (ST elevation/depression) 4. Holter monitoring- if there is Paroxysmal AF (check 24 hrs) 5. Echocardiogram- regional valvular wall abnormalities (evidence of MI)

Types of Stroke?

Ischemic stroke Hemorrhagic stroke • Intracerebral Hemorrhage • Subarachnoid Hemorrhage * to differentiate this two types, need to do brain imaging (MRI, Non-CT scan)

______________________ is another term for stroke. A. Brain attack B. Complex migraine C. Clot attack D. All of the above

The correct answer is A. Brain attack Stroke is also referred to as a "cerebrovascular accident" (CVA) or a "brain attack."

Which of the following is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent stroke? A. Non-contrast CT scanning B. Transcranial Doppler ultrasonography C. Echocardiography D. Single-photo emission CT (SPECT) scanning

The correct answer is A. Non-contrast CT scanning Emergent brain imaging is essential for confirming the diagnosis of ischemic stroke. Non contrast CT scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke. The non contrast CT scan is fast, readily available, and can identify intracranial hemorrhages allowing for proper selection of patients for reperfusion therapies. Transcranial Doppler ultrasonography is useful for evaluating more proximal vascular anatomy—including the middle cerebral artery, intracranial carotid artery, and vertebrobasilar artery—through the infratemporal fossa. Echocardiography is obtained in all patients with acute ischemic stroke in whom cardiogenic embolism is suspected. The use of SPECT scanning in stroke is still experimental and is available only at select institutions.

A stroke is a medical emergency. A. True B. False

The correct answer is A. True A stroke is a medical emergency. If you suspect you or someone you know is having a stroke, call 911. Stroke treatment with ''clotbuster'' medication is limited to the first three hours (may be 4.5 hours in certain cases) after symptom onset. It is critical to get to the hospital's emergency department as soon as a possible stroke is identified to improve outcomes. Calling 911 expedites stroke care and leads to a better recovery. The American Heart Association and the American Stroke Association suggest you know the signs of a stroke and act FAST: Face — Drooping Does one side of the face droop or is it numb? Ask the person to smile. Arm — Weakness Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward? Weakness or numbness usually appears on one side of the body. Speech Difficulty — Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like "the sky is blue." Is the sentence repeated correctly? Time to call 911 — If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately.

Which of the following is not a common sign or symptom of ischemic stroke? A. Hemisensory deficit B. Quadriparesis C. Hemiparesis D. Visual field loss

The correct answer is B. Quadriparesis Consider stroke in any patient presenting with acute neurologic deficit or any alteration in level of consciousness. Common signs and symptoms of stroke include the abrupt onset of any of the following: • Hemiparesis, monoparesis, or (rarely) quadriparesis • Hemisensory deficits • Monocular or binocular visual loss • Visual field deficits • Dysarthria • Facial droop • Ataxia • Vertigo (rarely in isolation) • Aphasia Although such symptoms can occur alone, they are more likely to occur in combination.

What is the major risk factor for stroke? A. Obesity B. Diabetes C. High Blood Pressure D. Family history of stroke

The correct answer is C. High Blood Pressure Modifiable: Stroke, MI, embolism, hypertension, DM, smoking, heavy alcohol consumption, AF, hyperlipidemia, OCP, Obesity Non-modifiable: Age > 65y/o, Gender, Family history of stroke

Which type of medicine is given to help prevent a stroke? A. Medicine to prevent clots from forming B. Blood-thinner medicine C. Clot-busting medicine D. A and B E. All of the above

The correct answer is D. A and B. Clot-preventing (antiplatelet) and blood-thinner (anticoagulant) medicines help prevent a stroke. Antiplatelet medicine prevents the blood from clotting by affecting how the platelets do their job, according to the NINDS. Reducing the risk for blood clots cuts the risk for ischemic stroke. Aspirin is the most commonly used antiplatelet medicine. Others that work include clopidogrel and ticlopidine. Anticoagulants also make blood less able to clot. Warfarin and heparin are 2 common anticoagulant medicines. Clot-busting (thrombolytic) medicine is given to a person having an ischemic stroke, or within 3 hours after stroke symptoms start. This helps prevent damage.

What is a stroke? A. Blocked blood vessel in the brain B. Bleeding in the brain from a blood vessel C. Loss of oxygen to part of the brain D. All of the above

The correct answer is D. All of the above A stroke is a result of low oxygen or low blood flow to an area of the brain. This can happen from a blood clot causing a blockage of blood flow (ischemic stroke), a leak in a blood vessel, or a burst blood vessel (hemorrhagic stroke). Blood carries oxygen to the tissues of the brain, and when blood flow is reduced part of the brain is permanently damaged.

Blood supply to the brain that is briefly interrupted describes a _________. A. Stroke B. Mini stroke C. Transient Ischemic Attack D. B & C only

The correct answer is D. B & C only A transient ischemic attack (TIA), also referred to as a mini-stroke, occurs when there is a temporary interruption on the blood flow to an area of the brain. The symptoms of a TIA generally last less than an hour, and always resolve within one day. They do not usually cause brain damage and may not be seen on conventional stroke testing (CAT scan). Mini-strokes are a warning that a damage-causing stroke may occur in the near future.

If a person has an ischemic stroke, how quickly should the person be treated to minimize long-term problems? A. Within 30 minutes B. Within 1 hour C. Within 2 hours D. Within 3 hours

The correct answer is D. Within 3 hours. Ischemic strokes are treated with a medicine called t-PA. This medicine dissolves blood clots blocking blood flow to the brain, according to the NINDS. To work as it should, the medicine must be given within 3 hours after stroke symptoms start. Because a person who may be having a stroke must be looked at by hospital staff, the NINDS says that the person must arrive at the hospital within an hour after the symptoms start.

Which of these may be a long-term problem after a stroke? A. Paralysis or weakness on one side of the body B. Problems with thinking or memory C. Problems with language D. Pain in the hands and feet E. All of the above

The correct answer is E. All of the above. Most stroke patients need some form of physical and occupational therapy. A person who has had a stroke may need help relearning basic skills such as how to walk, sit, stand, or lie down, according to the NINDS. The person may also need help with eating, drinking, dressing, bathing, cooking, and using the toilet.