Stroke Case Study Quiz

Questions and Answers

What are the general features associated with ischemic stroke and intracranial hemorrhage (ICH)?

The general features include loss of consciousness (LOC), vomiting, seizures, and headache (HA).

Describe the clinical implications of a middle cerebral artery (MCA) stroke.

An MCA stroke can cause contralateral weakness affecting the face and arm more than the leg, along with possible aphasia and sensory neglect.

What are the typical features of lacunar syndromes in stroke patients?

Lacunar syndromes often present as pure motor, pure sensory, sensorimotor, ataxic hemiparesis, or dysarthria-clumsy hand syndrome.

What are the key principles of acute ischemic stroke care?

The key principles are timely recanalization of the occluded artery, optimizing collateral flow, and avoiding secondary brain injury. Signup and view all the answers

List the imaging and blood work investigations recommended for stroke diagnosis.

Non-enhanced CT brain imaging and a blood workup including FBC, ESR, glucose, lipid profile, and kidney function tests are recommended. Signup and view all the answers

What is the target blood glucose level for managing hyperglycemia in stroke patients?

140 – 180 mg/dl (7.8 – 10 mmol/L) Signup and view all the answers

When should thrombolysis be administered in the case of ischemic stroke?

Within 3 – 4.5 hours of stroke onset. Signup and view all the answers

What medication is recommended for daily use in patients post-stroke management?

ASA 300mg daily. Signup and view all the answers

What is the recommended blood pressure reduction strategy for patients with an SBP > 220 mmHg?

Aggressive reduction with a titratable agent and intensive monitoring. Signup and view all the answers

Why is it important to evaluate for other causes of intracerebral hemorrhage (ICH) in elderly patients?

They may present with atypical locations of the bleed and have different risk factors. Signup and view all the answers

What should be avoided in the first 48 - 72 hours post-ICH treatment?

Anticoagulants. Signup and view all the answers

What is a common cause of cardioembolic strokes?

Atrial fibrillation. Signup and view all the answers

What are neurologic symptoms in cardioembolic stroke characterized by?

Symptoms that are maximal at onset. Signup and view all the answers

What does a stroke syndrome that involves a large artery territory and cortical involvement suggest?

It suggests a cardioembolic source. Signup and view all the answers

What CHADS2 score indicates a need for anticoagulation in patients with atrial fibrillation?

A CHADS2 score of ≥ 2 indicates a need for anticoagulation. Signup and view all the answers

What is the target INR range for patients with cardioembolic stroke receiving anticoagulation?

The target INR range is between 2 and 3. Signup and view all the answers

What does a HAS-BLED score of ≥ 3 signify in the context of anticoagulation?

It signifies a need for caution due to potential bleeding risks. Signup and view all the answers

Identify a common complication of stroke related to the central nervous system (CNS).

Hematoma growth (ICH) is a common CNS complication. Signup and view all the answers

What role does physiotherapy play in stroke rehabilitation?

Physiotherapy aids in regaining physical function and mobility. Signup and view all the answers

What scoring system is used for risk stratification after a TIA?

The ABCD2 score is used for TIA risk stratification. Signup and view all the answers

What lifestyle modification can be beneficial for secondary prevention of stroke?

Lifestyle modifications include managing hypertension and diabetes. Signup and view all the answers

What characterizes an episode classified as a transient ischemic attack (TIA)?

A TIA is characterized by neurological symptoms lasting less than 24 hours. Signup and view all the answers

What are the primary classifications of cerebrovascular disorders according to the ICD system?

TIA, cerebral ischemic stroke, Intracerebral hemorrhage (ICH), and Subarachnoid hemorrhage (SAH). Signup and view all the answers

What is the key difference between a stroke and a transient ischemic attack (TIA)?

A stroke causes lasting neurological deficits, while a TIA is temporary and leaves no persistent neurological damage. Signup and view all the answers

Identify the two main types of strokes and their approximate prevalence.

The two main types of strokes are ischemic stroke (80%) and hemorrhagic stroke (20%). Signup and view all the answers

Explain the role of hypertension in stroke risk as exemplified in the cases provided.

Hypertension is a significant risk factor for stroke; it can lead to both ischemic strokes and hemorrhagic strokes due to vascular damage. Signup and view all the answers

Explain the difference between a completed stroke and a progressive stroke.

A completed stroke shows a complete focal neurological deficit lasting over 24 hours, while a progressive stroke exhibits worsening symptoms over time but also lasts more than 24 hours. Signup and view all the answers

List two non-modifiable and two modifiable risk factors for stroke.

Non-modifiable risk factors include age and race; modifiable risk factors include hypertension and diabetes mellitus. Signup and view all the answers

Describe the clinical presentation of a patient experiencing a right facial nerve palsy due to stroke.

The patient exhibits slurred speech, inability to walk, and right-sided facial weakness, indicating neurological deficits. Signup and view all the answers

What are common symptoms of a patient experiencing an intracerebral hemorrhage (ICH)?

Symptoms include rapidly developing neurological dysfunction, headache, and possible loss of consciousness. Signup and view all the answers

What is the role of chronic hypertension in causing hemorrhagic stroke?

Chronic hypertension can lead to the rupture of Charcot-Bouchard aneurysms, contributing to hemorrhagic stroke. Signup and view all the answers

What are the primary mechanisms through which hemorrhagic stroke disrupts neuronal activity?

Hemorrhagic stroke disrupts neuronal activity through compression of neurons and vessels, cerebral edema, and vasospasm. Signup and view all the answers

Identify the features that distinguish an ischemic stroke from a hemorrhagic stroke.

An ischemic stroke is due to blockage of blood flow, while a hemorrhagic stroke involves bleeding into the brain tissue. Signup and view all the answers

What is the Glasgow Coma Scale (GCS) and why is it important in evaluating stroke patients?

The GCS measures a patient's level of consciousness, providing important information about brain function status following a stroke. Signup and view all the answers

Define the term 'cerebral venous thrombosis' and its consequence.

Cerebral venous thrombosis is thrombosis of a cerebral venous structure leading to infarction or hemorrhage in the brain. Signup and view all the answers

What is the significance of the Circle of Willis in relation to blood supply to the brain?

The Circle of Willis serves as a critical anastomosis for the anterior and posterior circulations, ensuring adequate cerebral blood supply. Signup and view all the answers

What is the significance of a positive Kernig's sign in a neurological examination?

A positive Kernig's sign indicates meningeal irritation, which may suggest conditions like subarachnoid hemorrhage. Signup and view all the answers

Study Notes

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.

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Description

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.