Stroke Case Study Quiz

Stroke Overview

• Stroke is characterized by rapidly developing signs of focal or global cerebral function disturbances, lasting over 24 hours or leading to death, of vascular origin.
• Transient Ischemic Attack (TIA) is a temporary episode of focal neurological dysfunction, lasting from 2 to 24 hours, without permanent deficits.

Case Studies

• Mr. AZ (70 years old):
  • History of hypertension (HTN) and type 2 diabetes mellitus (T2DM)
  • Found unresponsive; Glasgow Coma Scale (GCS) 8/15, anisocoria, left facial deviation, and no motor response on the right side.
• Mrs. BY (65 years old):
  • Good adherence to T2DM medication.
  • Sudden onset slurred speech and inability to walk; GCS 15/15, right facial nerve palsy, and marked motor deficits.
• 42-year-old male:
  • Sudden severe headache with vomiting, LOC, GCS 14/15, and positive Kernig's sign; no motor deficits.

Stroke Classification

• Classified into ischemic stroke (80%) and hemorrhagic stroke (20%).
• Ischemic Stroke:
  • Thrombotic (50%) and embolic (30%).
• Hemorrhagic Stroke:
  • Intracerebral hemorrhage (15%) and subarachnoid hemorrhage (5%).

Risk Factors

• Non-modifiable: Age, race, male gender, family history.
• Modifiable: Hypertension, diabetes mellitus, smoking, alcohol consumption, dyslipidemia, physical inactivity, cardiac risk factors, and other conditions (e.g., vasculitis).

Hemorrhagic Stroke Causes

• Chronic hypertension, arteriovenous malformations (AV malformations), amyloid angiopathy, anticoagulant therapy, amphetamines, and drugs like cocaine.

Pathophysiology

• Ischemic Stroke: Due to lack of blood supply leading to neuron death.
• Hemorrhagic Stroke: Blood entry into the brain disrupts neuronal activity, causing increased intracranial pressure, edema, and potential herniation.

Clinical Features

• Common symptoms include loss of consciousness (LOC), vomiting, and headache.
• Middle Cerebral Artery (MCA) strokes often cause contralateral weakness and aphasia.
• Posterior Cerebral Artery (PCA) strokes may present with homonymous hemianopia.

Investigations

• Non-enhanced CT brain, blood work (including glucose and lipid profile), ECG, and potential carotid Doppler imaging for ischemic strokes.

Acute Ischemic Stroke Management

• Timely recanalization of occluded arteries is critical.
• Treatment includes thrombolysis within 3-4.5 hours of onset, antiplatelet therapy, and controlling hyperglycemia.

Management of Intracerebral Hemorrhage

• Rapid evaluation using non-contrast CT and managing blood pressure to prevent hematoma expansion.
• Avoidance of NSAIDs and careful use of anticoagulants within the acute phase.

Cardioembolic Stroke

• Often caused by atrial fibrillation; stroke prevention includes anticoagulation based on risk stratification scores like CHADS2 and CHA2DS2-VASc.

Secondary Stroke Prevention

• Lifelong antiplatelet therapy and statin usage post-ischemic stroke.
• Lifestyle modifications and rehabilitation through physiotherapy, occupational therapy, and speech therapy.

Complications of Stroke

• Include recurrent strokes, seizures, pulmonary complications, deep vein thrombosis (DVT), and psychological issues such as depression.

Risk Stratification for TIA

• ABCD2 score to assess stroke risk following TIA; includes age, blood pressure, clinical features, duration of symptoms, and diabetes presence.
• Neuroimaging (MRI) is suggested for further evaluation in suspected TIA patients.

This quiz examines clinical case studies of stroke patients, highlighting key symptoms and medical histories. It assesses knowledge on identifying stroke signs, risk factors such as hypertension and diabetes, and the implications of medication adherence. Test your understanding of stroke management and patient care.