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Questions and Answers
Which of the following is a modifiable risk factor for stroke according to the text?
Which of the following symptoms is NOT commonly associated with stroke according to the text?
Which artery supplies the medial side of the brain according to the text?
Which type of stroke usually spares language, spatial, and visual functions according to the text?
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Which of the following is NOT one of the objectives mentioned in the text?
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What is the main cause of damage in a stroke?
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What is the recommended treatment for Mr. Francisco's elevated blood pressure?
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Which arteries are involved in the pathophysiology of lacunar infarcts?
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Which imaging technique is useful for detecting small areas of ischemia or infarction that might not be seen with CT?
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What is the recommended time frame for administering tPa for ischemic stroke?
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What is the benefit of giving ASA and/or clopidogrel acutely in acute stroke treatment?
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Which of the following is a risk factor for stroke?
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What is the difference between a TIA and a stroke?
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What is the significance of Mr. Francisco's symptoms of decreased vision in the left eye?
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Which arteries form the posterior circulation of the brain?
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Which arteries form the anterior circulation of the brain?
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What is the function of the Circle of Willis?
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What is the purpose of imaging techniques like angiograms and MR-angiograms?
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Which one of the following is the common indication for anticoagulation in stroke patients?
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What is the purpose of carotid endarterectomy?
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What is the goal of rehabilitation in a rehabilitation hospital?
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What is the purpose of doppler ultrasound in carotid artery imaging?
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Which of the following is true about the ischemic penumbra?
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What determines whether the cells in the ischemic penumbra survive or not?
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What is the recommended time window for administering tPa for acute stroke?
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When is thrombectomy beneficial for patients with a proximal vessel occlusion?
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Dr. Olajide Williams is a Neurologist and Stroke ______ at Columbia University.
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The founder of Hip Hop Public Health is ______.
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The principles of acute stroke treatment include the idea that 'time is ______'.
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Mr. Francisco's blood pressure is ______.
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Primary Prevention Block C Hypertension most important for ______
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The brain is supplied with blood by the two internal carotid and two vertebral ______
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The ______ artery terminates by dividing into the two posterior cerebral arteries
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The ______ communicating artery connects the other vessels to form the Circle of Willis
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Mr. Francisco has weakness of the left side of the face (sparing the ______*).
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The symptoms tell us which ______ might be affected and where to look on imaging.
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A stroke involving only the brainstem can produce quite varied ______.
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The blue infarct is in the deep white matter of the frontal lobe. This is important for functions like judgment and personality that involve ______ areas of the brain.
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Anticoagulation is the only common indication for ______ in stroke patients
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The Stroke Team includes a nurse, physiotherapy, occupational therapy, speech therapy, social worker, and ______
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Patients with a symptomatic ICA stenosis of 70%-99% benefit from a ______
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The goal of rehabilitation in a rehabilitation hospital is to maximize experience-dependent ______ and develop intact brain regions taking compensatory strategies to improve
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Risk factor modification includes ______, ______, and ______.
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Patients may ask their doctor, 'What else can I do?' In addition to diet and exercise, consider talking about ______.
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A transient ischemic attack (TIA) is defined as a transient neurological deficit caused by ischemia with full resolution within ______ hours.
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Most TIAs last ______ minutes to 1 hour.
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Longer events are probably ______.
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A TIA is more concerning than a stroke.
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Lyse (remove) ______. Improve collateral circulation. Rescue penumbra (the area of ischemia surrounding the core infarct).
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Whether the cells in the ______ survive depends on: 1. How well the other vessels (termed 'collateral vessels') maintain blood flow to the area and/or 2. If blood flow in the centre artery can be restored
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Patients with evidence on CTA of a proximal vessel occlusion (e.g. MCA) benefit from (physical) ______ removal up to 12 hours or more after onset.
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After receiving iv tPa, Mr. Francisco has some slight improvement in strength of his left arm. What ______. Mr. Francisco is admitted to hospital. There are two parallel objectives: 1. Identify and treat the cause to prevent recurrence 2. Aid adaptation and recovery
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Acute stroke treatment options include: ASA and/or ______* iv tPa (tissue plasminogen activator) Thrombectomy In each case these would be offered only after confirming the absence of a hemorrhage with a CT scan
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Block C tPa catalyses formation of plasmin from plasminogen, with lysis of ______
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tPa given within 4.5 hours for ______ results in better functional outcomes at 3 months. The graphs to the left show data from the original NINDS tPA trial (top) and a later meta-analysis (bottom, colour). NINDS NEJM 1995 They show the percentage of patients with scores on different functional scales used to assess stroke outcome. Being towards the left for each scale is better. For example, in the bottom graph there are more tPa patients than placebo patients with scores of 0-1. Hacke NEJM 2008 What does tPa really do. These are the same images shown previously, before this patient received tPa… Wechsler NEJM 2011 The entire dark blue area has reduced blood flow…it is at risk of infarction (= cell death) What does tPa really do. …and now post-tPa. There is an area of infarction (arrows) but it is much smaller than the “perfusion defect” on the preceding slide.
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A few points to remember: 1. CT changes in stroke (hypodensity) take time to appear 2. We look for subtle blurring of normal anatomy* 3. CTA is being routinely used in acute stroke 4. Diffusion-weighted MRI can help *Rarely we can see the thrombus itself appearing as a hyperdensity (brighter) within the ______
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