29 Questions
What is the most common cause of stroke in developed countries?
Thrombotic stroke
Which type of stroke is mainly associated with unrecognized or poorly controlled hypertension?
Primary Intracerebral Haemorrhage (PICH)
Which classification of stroke is characterized by a focal neurologic deficit lasting less than 24 hours?
Transient Ischemic attack
What is the primary contraindication for thrombolytic therapy with rt-PA in the management of Atherosclerotic stroke (Thrombotic stroke)?
Recent surgery
What is the indicated medical therapy for preventing neurologic deterioration due to vasospasm in the management of Subarachnoid haemorrhage?
Nimodipin (calcium channel blocker)
What is the general recommendation for anticoagulation treatment in the management of Embolic stroke (cardiogenic embolus)?
Use warfarin for chronic anticoagulation
What is a major risk factor for stroke?
Atrial fibrillation
Which imaging study is more sensitive for early brain infarction diagnosis?
MRI
What is the goal of treatment for specific stroke management?
Prevention and management of complications
Ischemic stroke accounts for 80 – 90% of all stroke in developed countries. The three main subtypes of ischemic stroke are a) ________ b) ________ and c) ________.
a) Embolic b) Thrombotic c) Miscellaneous
Transient Ischemic attack: TIAs are focal neuralgic deficit lasting less than ________ confined to an area of brain perfused by specific artery.
less than 24 hrs
Reversible Ischemic neurologic deficit: sudden onset focal neurologic deficit which lasts for more than ________, but the neurologic deficit recovers / resolves.
24 hours
_______ factors for stroke include demographic factors (higher in men and older age), Pyramid DM, hypertension, hyperlipidemia, cardiac issues (atrial fibrillation, myocardial infarction, congestive heart failure), substance abuse (acute alcohol abuse, smoking)
Major risk
Fever raises suspicion for ______ aetiologies
infectious
CT shows complete infarction after 24 hours, MRI is more sensitive for early brain infarction ______
diagnosis
Thrombolytic therapy with rt-PA is indicated for patients who present within _______ of onset of stroke
3 hrs
Heparin and warfarin use in the management of Atherosclerotic stroke (Thrombotic stroke) is _______
controversial
Anticoagulation with heparin should be initiated when the acute phase of stroke is _______
over
Saccular aneurysms in the management of prevention of further stroke are _______ surgically
treated
Match the following stroke classification with their descriptions:
Ischemic stroke - Embolic = Resulting from dislodged thrombi or other material that forms outside the brain Ischemic stroke - Thrombotic = Resulting from narrowing of cerebral arteries due to atherosclerosis Hemorrhagic Stroke - Primary Intracerebral Haemorrhage (PICH) = Caused by the rupture of a blood vessel in the brain Hemorrhagic Stroke - Subarachnoid Haemorrhage (SAH) = Bleeding within the subarachnoid space
Match the following stroke classification with their associated percentage of occurrence:
Ischemic stroke = 80 – 90% in developed countries Hemorrhagic Stroke = 10-20% of cerebrovascular accidents in developed nations Transient Ischemic attack (TIA) = Focal neuralgic deficit lasting less than 24 hrs confined to an area of brain perfused by specific artery Reversible Ischemic neurologic deficit = Sudden onset focal neurologic deficit which lasts for more than 24 hours
Match the following stroke classification with their progression characteristics:
Transient Ischemic attack (TIA) = Resolves in less than 24 hours Reversible Ischemic neurologic deficit = Neurologic deficit recovers / resolves after more than 24 hours Stroke in evolution = Progressing degree of focal neurologic deficit over a couple of hours or days Ischemic stroke - Small vessel disease (Lacunar infarct) = One of the subtypes of ischemic stroke
Match the following stroke risk factors with their association:
Pyramid DM = Associated with increased risk of stroke Hypertension = Associated with increased risk of stroke Atrial fibrillation = Associated with increased risk of stroke Smoking = Associated with increased risk of stroke
Match the following imaging studies with their purpose in stroke diagnosis:
CT = Identification or exclusion of hemorrhagic stroke and other conditions mimicking stroke MRI = More sensitive for early brain infarction diagnosis Carotid Doppler studies = Evaluation of carotid arteries for atherosclerosis or stenosis Angiography = Visualize blood vessels in the brain to identify aneurysms or malformations
Match the following stroke subtype with its associated physical examination findings:
Embolic/Ischemic stroke = Absent/reduced peripheral pulses, neck bruit, cardiac abnormalities Haemorrhagic stroke = Ophthalmoscopic examination for papilledema or retinal hemorrhage Ischemic stroke = Fever raises suspicion for infectious etiologies Thrombotic stroke = Clinical features include mode of onset and pattern of progression, prior history of TIAs, associated symptoms, and risk factors
Match the following stroke management measures with their corresponding types of stroke:
Thrombolytic therapy with rt-PA = Atherosclerotic stroke (Thrombotic stroke) Anticoagulation with heparin and warfarin = Atherosclerotic stroke (Thrombotic stroke) Anticoagulation for preventing recurrent embolic stroke = Embolic stroke (cardiogenic embolus) Control of chronic diseases and lifestyle modifications = Prevention of further stroke
Match the following imaging studies with their corresponding stroke diagnosis:
CT scan = Intracerebral haemorrhage MRI = Ischemic stroke CT and MRI = Subarachnoid haemorrhage CT angiography = Atherosclerotic stroke (Thrombotic stroke)
Match the following supportive measures with their corresponding types of stroke:
Control of very high blood pressure = Intracerebral haemorrhage Bed rest, sedatives, and analgesics = Subarachnoid haemorrhage Nimodipine (calcium channel blocker) = Subarachnoid haemorrhage Fluid administration /Hydration = Atherosclerotic stroke (Thrombotic stroke)
Match the following medication therapies with their corresponding types of stroke:
Aspirin 75 mg PO daily = Prevention of further stroke Low dose heparin for prevention of thromboembolism = Atherosclerotic stroke (Thrombotic stroke) Anticoagulation with heparin to prevent recurrent embolic stroke = Embolic stroke (cardiogenic embolus) Thrombolytic therapy with rt-PA within 3 hrs of onset of stroke = Atherosclerotic stroke (Thrombotic stroke)
Study Notes
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Complete stroke: sudden onset of focal neurological deficit, with no improvement or worsening, often related to cerebral infarction
-
Major risk factors for stroke include demographic factors (higher in men and older age), Pyramid DM, hypertension, hyperlipidemia, cardiac issues (atrial fibrillation, myocardial infarction, congestive heart failure), substance abuse (acute alcohol abuse, smoking)
-
Goals in managing a patient with stroke: assessment and maintenance of vital functions, determination of presumptive diagnosis of stroke subtype, confirmation of stroke subtype, and management of the patient
-
Initial assessment and maintenance of vital functions: maintenance of airway and ventilation, control of blood pressure, control of body temperature, fluid management
-
Assessment of vital functions: maintain airway and ventilation - monitor intubated patients or provide supplemental oxygen if needed; control blood pressure - monitor and correct both hypotension and hypertension; control body temperature - fever worsens stroke prognosis, so maintain appropriate temperature; fluid management - maintain euvolemic state and establish IV access using normal saline, avoid glucose solutions
-
Determining presumptive diagnosis of stroke subtype: important clinical features include mode of onset and pattern of progression, prior history of TIAs, associated symptoms, and risk factors
-
Physical examination findings may suggest stroke subtype: Embolic/Ischemic stroke - absent/reduced peripheral pulses, neck bruit, cardiac abnormalities; Haemorrhagic stroke - ophthalmoscopic examination for papilledema or retinal haemorrhage; Fever raises suspicion for infectious aetiologies
-
Imaging studies: CT or MRI for identification or exclusion of hemorrhagic stroke and other conditions mimicking stroke; CT shows complete infarction after 24 hours, MRI is more sensitive for early brain infarction diagnosis
-
Investigations: Carotid Doppler studies, angiography, echocardiography, ECG, CBC, ESR, VDRL, HIV infection tests, fasting blood glucose, lipid profile, coagulation profile
-
Management of specific stroke: goal of treatment - interruption of further brain damage, prevention and management of complications; general measures - admit patients for close follow-up, continue follow-up and maintenance of vital functions.
-
Complete stroke: sudden onset of focal neurological deficit, with no improvement or worsening, often related to cerebral infarction
-
Major risk factors for stroke include demographic factors (higher in men and older age), Pyramid DM, hypertension, hyperlipidemia, cardiac issues (atrial fibrillation, myocardial infarction, congestive heart failure), substance abuse (acute alcohol abuse, smoking)
-
Goals in managing a patient with stroke: assessment and maintenance of vital functions, determination of presumptive diagnosis of stroke subtype, confirmation of stroke subtype, and management of the patient
-
Initial assessment and maintenance of vital functions: maintenance of airway and ventilation, control of blood pressure, control of body temperature, fluid management
-
Assessment of vital functions: maintain airway and ventilation - monitor intubated patients or provide supplemental oxygen if needed; control blood pressure - monitor and correct both hypotension and hypertension; control body temperature - fever worsens stroke prognosis, so maintain appropriate temperature; fluid management - maintain euvolemic state and establish IV access using normal saline, avoid glucose solutions
-
Determining presumptive diagnosis of stroke subtype: important clinical features include mode of onset and pattern of progression, prior history of TIAs, associated symptoms, and risk factors
-
Physical examination findings may suggest stroke subtype: Embolic/Ischemic stroke - absent/reduced peripheral pulses, neck bruit, cardiac abnormalities; Haemorrhagic stroke - ophthalmoscopic examination for papilledema or retinal haemorrhage; Fever raises suspicion for infectious aetiologies
-
Imaging studies: CT or MRI for identification or exclusion of hemorrhagic stroke and other conditions mimicking stroke; CT shows complete infarction after 24 hours, MRI is more sensitive for early brain infarction diagnosis
-
Investigations: Carotid Doppler studies, angiography, echocardiography, ECG, CBC, ESR, VDRL, HIV infection tests, fasting blood glucose, lipid profile, coagulation profile
-
Management of specific stroke: goal of treatment - interruption of further brain damage, prevention and management of complications; general measures - admit patients for close follow-up, continue follow-up and maintenance of vital functions.
-
Complete stroke: sudden onset of focal neurological deficit, with no improvement or worsening, often related to cerebral infarction
-
Major risk factors for stroke include demographic factors (higher in men and older age), Pyramid DM, hypertension, hyperlipidemia, cardiac issues (atrial fibrillation, myocardial infarction, congestive heart failure), substance abuse (acute alcohol abuse, smoking)
-
Goals in managing a patient with stroke: assessment and maintenance of vital functions, determination of presumptive diagnosis of stroke subtype, confirmation of stroke subtype, and management of the patient
-
Initial assessment and maintenance of vital functions: maintenance of airway and ventilation, control of blood pressure, control of body temperature, fluid management
-
Assessment of vital functions: maintain airway and ventilation - monitor intubated patients or provide supplemental oxygen if needed; control blood pressure - monitor and correct both hypotension and hypertension; control body temperature - fever worsens stroke prognosis, so maintain appropriate temperature; fluid management - maintain euvolemic state and establish IV access using normal saline, avoid glucose solutions
-
Determining presumptive diagnosis of stroke subtype: important clinical features include mode of onset and pattern of progression, prior history of TIAs, associated symptoms, and risk factors
-
Physical examination findings may suggest stroke subtype: Embolic/Ischemic stroke - absent/reduced peripheral pulses, neck bruit, cardiac abnormalities; Haemorrhagic stroke - ophthalmoscopic examination for papilledema or retinal haemorrhage; Fever raises suspicion for infectious aetiologies
-
Imaging studies: CT or MRI for identification or exclusion of hemorrhagic stroke and other conditions mimicking stroke; CT shows complete infarction after 24 hours, MRI is more sensitive for early brain infarction diagnosis
-
Investigations: Carotid Doppler studies, angiography, echocardiography, ECG, CBC, ESR, VDRL, HIV infection tests, fasting blood glucose, lipid profile, coagulation profile
-
Management of specific stroke: goal of treatment - interruption of further brain damage, prevention and management of complications; general measures - admit patients for close follow-up, continue follow-up and maintenance of vital functions.
Test your knowledge of the aetiological classification of stroke including ischemic stroke and hemorrhagic stroke, as well as their subtypes such as embolic, thrombotic, large vessel disease, small vessel disease, and miscellaneous causes.
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