46 Questions
What is a characteristic symptom of a stroke that affects one side of the body?
Unilateral weakness of the face, arm, and leg
What is the primary basis for the Bamford classification system for ischemic stroke?
Presenting symptoms and clinical signs
What distinguishes a total anterior circulation stroke (TACS) from a partial anterior circulation stroke (PACS)?
Severity of the stroke
What is a characteristic feature of global neurological dysfunction?
Confusion and transient loss of consciousness
What is a condition that may mimic a stroke?
Migraine
What are the three requirements for a diagnosis of total anterior circulation stroke (TACS)?
Unilateral weakness, homonymous hemianopia, and higher cerebral dysfunction
What is the minimum number of symptoms required for a diagnosis of PACS?
Two
Which of the following is NOT a symptom of POCS?
Dysphasia
What is the primary characteristic of a lacunar stroke?
Blockage of a small artery deep in the brain
What is the term for a stroke that involves the middle cerebral artery?
Middle cerebral artery stroke
What is the purpose of the ABCD2 score?
To estimate the risk of stroke following a TIA
What percentage of stroke cases are hemorrhagic strokes?
13%
What is the term for a sudden loss of brain function?
Stroke
What is the term for a temporary loss of brain function?
TIA
What is the term for a blockage of a small artery deep in the brain?
Lacunar stroke
What is the term for a stroke that involves the posterior circulation?
POCS
What is the condition in which amyloid proteins build up on the walls of the arteries in the brain?
Cerebral Amyloid Angiopathy (CAA)
What is the term for a bulge in a blood vessel caused by a weakness in the blood vessel wall?
Aneurysm
What is the type of hemorrhagic stroke that occurs when a blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and the skull?
Subarachnoid Hemorrhage
What is the term for an abnormal tangle of blood vessels connecting arteries and veins that can disrupt normal blood flow and oxygen circulation?
Arteriovenous Malformation (AVM)
What is the term for bleeding into the tissue deep within the brain?
Intracerebral Hemorrhage
What is the imaging test commonly used to diagnose hemorrhagic stroke?
CT scan
What is the term for a procedure where a tiny clamp is placed at the base of an aneurysm to halt blood flow to it?
Surgical Clipping
What is the term for a procedure where tiny detachable coils are inserted into the aneurysm using a catheter?
Embolization
What is the term for the removal of an AVM surgically?
Surgical AVM Removal
What is the time window for IV thrombolysis or endovascular thrombectomy in acute ischemic stroke?
30 minutes after arrival in hospital
What is a necessary condition for initiating thrombolysis in a patient with ischemic stroke symptoms?
The patient's symptoms must be disabling and persist after glucose normalization.
What is a contraindication for IV thrombolysis in acute ischemic stroke?
Gastrointestinal or genitourinary bleeding within the last 21 days.
What is the recommended time frame for initiating thrombolysis treatment?
Within 4.5 hours of last known well time.
What is the recommended next step if a patient's stroke symptoms persist after glucose normalization?
Treat with IV alteplase.
What is the primary agent used for thrombolysis in acute ischemic stroke?
Alteplase.
What is a consideration for exclusion from thrombolysis?
Recent major surgery or major trauma.
What is the recommended procedure for removing a thrombus under image guidance?
Thrombectomy.
What is a consideration for thrombolysis between 4.5 and 9 hours?
CT/MR perfusion findings are favorable with a small core and large penumbra.
What is a contraindication for IV thrombolysis if a patient has taken a novel oral anticoagulant (DOAC)?
Within the last 48 hours.
What is the recommended approach if a patient has a wake-up stroke or unknown time of onset?
Neurology consultation with advanced imaging.
What is the primary goal of emergency treatment for hemorrhagic stroke?
Controlling the bleeding and reducing pressure in the brain
What is the recommended time window for deciding on IV thrombolysis or endovascular thrombectomy?
Within 30 minutes of arrival in hospital
What is the minimum age requirement for IV thrombolysis treatment?
≥ 18 years
What is the primary benefit of administering IV tPA in acute ischemic stroke?
Improving the patient's neurological outcomes
What is the recommended time for follow-up CT brain after thrombolysis or thrombectomy?
At 24 hours after the procedure
What is the primary goal of stroke unit care?
Producing the best outcomes following thrombolysis or thrombectomy
What is the primary mechanism of action of thrombolytic agents in acute ischemic stroke?
Breaking down blood clots in the brain
What is the primary complication of immobility in stroke patients?
Pressure injuries
What is the primary goal of aspirin administration after thrombolysis or thrombectomy?
Preventing further ischemic strokes
What is the primary method of blood clot removal in thrombectomy?
Mechanical breakdown of the clot
Study Notes
Stroke Diagnosis and Classification
• Stroke presents with abrupt onset, focal neurological signs, and symptoms, often affecting one side of the body. • The Bamford classification system is commonly used to classify ischemic stroke into: + Total Anterior Circulation Stroke (TACS) + Partial Anterior Circulation Stroke (PACS) + Posterior Circulation Syndrome (POCS) + Lacunar Stroke (LACS) • Each type of stroke has specific diagnostic criteria, including symptoms and signs.
Conditions that Mimic Stroke
• Transient Ischemic Attack (TIA) • Seizure • Migraine • Hypoglycemia • Hypotension • Brain neoplasm • CNS infections • Each of these conditions has distinct characteristics and features that can help distinguish them from stroke.
Hemorrhagic Stroke
• Accounts for about 13% of stroke cases • Caused by a weakened vessel that ruptures and bleeds into the surrounding brain • The most common causes of hemorrhagic stroke are: + Hypertension + Cerebral Amyloid Angiopathy (CAA) + Aneurysm + Arteriovenous Malformation (AVM) • Emergency treatment focuses on controlling bleeding and reducing pressure in the brain.
Treatment Options for Acute Ischemic Stroke
• Thrombolysis • Thrombectomy • The care team should decide if IV thrombolysis or endovascular thrombectomy is indicated within 30 minutes after arrival in hospital. • IV thrombolysis treatment should be implemented provided that: + Treatment can be initiated within 4.5 hours of last known well time (LKWT) + Patient is ≥ 18 years + No exclusion criteria are present • Tissue plasminogen activator (tPA) is the thrombolytic agent used to break down blood clots.
Post-Stroke Complications
• Delirium • Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) • Pneumonia • Infections • Aspiration • Bowel/bladder dysfunction • Myocardial infarction • Heart failure • Pressure injuries • Depression • Pain • These complications can arise following a stroke, and healthcare professionals must seek to prevent them and detect them early to initiate treatment.
This quiz helps identify conditions that mimic stroke symptoms, including seizures, migraines, hypoglycemia, and brain neoplasms. Learn to differentiate stroke from other causes of focal neurological signs and symptoms.
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