Stroke Overview and Advances

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What best defines a stroke?

A sudden neurologic event of vascular origin. (correct)

A temporary loss of consciousness.

A chronic condition affecting blood flow.

A gradual decline in cognitive function.

What is the primary purpose of early treatment in a stroke unit?

To initiate thrombolysis within a critical time frame. (correct)

To ensure a thorough physical examination is completed.

To perform surgical intervention immediately.

To assess the patient's medical history in detail.

Which of the following is NOT a risk factor for stroke prevention?

Regular physical activity. (correct)

Diabetes mellitus.

Hyperlipidemia.

Hypertension.

What are the components of the Circle of Willis associated with strokes?

It includes major arteries supplying the brain, facilitating collateral circulation. Signup and view all the answers

Transient Ischaemic Attack (TIA) is best described as:

A temporary episode of reduced blood flow to the brain lasting less than 24 hours. Signup and view all the answers

What is a common feature of stroke units regarding patient evaluation?

They emphasize early recognition and treatment within 3 to 4 hours. Signup and view all the answers

Which of the following statements best characterizes a Transient Ischaemic Attack (TIA)?

It is a temporary period of neurological dysfunction. Signup and view all the answers

What distinguishes the types of stroke observed in young adults versus older individuals?

Causes for stroke can vary significantly with age, including lifestyle factors in younger populations. Signup and view all the answers

What does the term 'raised intracranial pressure' suggest in the context of stroke complications?

It reflects potential life-threatening complications that require urgent intervention. Signup and view all the answers

Which factor is crucial in the acute investigation of a stroke?

Conducting thorough neuroimaging to confirm the type of stroke. Signup and view all the answers

What primarily contributes to the occurrence of Ischemic Stroke?

Thrombosis or embolism affecting blood flow Signup and view all the answers

Which of the following is a common risk factor related to vessel wall issues for stroke?

Diabetes contributing to vascular damage Signup and view all the answers

Which type of hemorrhagic stroke is characterized by bleeding within the brain tissue?

Intracerebral hemorrhage occurring inside the brain Signup and view all the answers

What percentage of strokes are categorized as hemorrhagic according to the provided summary?

12% Signup and view all the answers

Which of the following lifestyle factors is recognized as a risk factor for stroke?

Obesity contributing to overall cardiovascular risk Signup and view all the answers

What percentage of strokes are classified as Ischemic Stroke?

65% Signup and view all the answers

Which of the following factors is considered a vessel lumen issue related to stroke risk?

Atrial fibrillation Signup and view all the answers

Which type of hemorrhagic stroke involves bleeding between the brain and the outermost covering of the brain?

Subarachnoid hemorrhage Signup and view all the answers

What is a common risk factor for strokes associated with lifestyle choices?

Oral contraceptives Signup and view all the answers

What best describes a Transient Ischemic Attack (TIA)?

Temporary neurological dysfunction without lasting damage Signup and view all the answers

Study Notes

Stroke Overview

Stroke is a sudden neurological event of vascular origin.
Stroke may be acute ischemic stroke (infarction, embolus, thrombus), hemorrhagic stroke (intracerebral, subarachnoid), or transient ischemic attack (TIA).

Learning Objectives

Define "stroke".
Describe the Circle of Willis and extracranial cerebral circulation.
Understand Transient Ischemic Attack (TIA).
Know stroke causes and types in young and old individuals.
Understand stroke prevention factors.
Know acute stroke investigation and management principles.
Understand the natural history of acute stroke.

Stroke Advances

Stroke units - full workup within 3-4 hours, enabling early recognition and neuroimaging.
Early treatment - thrombolysis (door to needle < 60 min) and clot retrieval.
Stroke prevention - risk factor management.
Neurorehabilitation - intensive care.

Stroke Mimics

Conditions to watch out for include: hypoglycaemia, mass lesions, seizures, migraine, functional hemiparesis, toxic/metabolic encephalopathy.
Be aware of disguised strokes (movement disorders, confusion, vomiting).

Frequency of Stroke by Type

Acute ischemic stroke - 65%+ (infarction - thromboembolic).
Hemorrhage - 12% (subarachnoid - 6.6%, intracerebral - 5.1%).
Transient ischemic attack (TIA) - 21%.

Stroke Risk Factors

Vessel Wall: Hypertension, smoking, atherosclerosis, hyperlipidemia, diabetes.
Vessel Lumen: Embolism (heart disease, impaired cardiac function, CHD, AFib, LVH, valvular disease), thrombosis (hematocrit, fibrinogen).
Other: Race, family history, oral contraceptives, obesity.

Young Stroke (<50)

All risk factors above.
Vessel wall disease (large vessel, fibromuscular dysplasia, dissection, migraine).
Small vessel disease (vasculitis, drug-induced, sickle cell anemia, anti-phospholipid syndrome).
Congenital heart disease and complications (valve prolapse, patent foramen ovale).

Cerebral Autoregulation

Pressure-dependent cerebral blood flow.
Ischemic thresholds - electrical failures, complete ion pump failures, K+ release, failure to clear extracellular fluid (ECF), and cell death.
Vasodilation in metabolically active tissue (increased blood flow & swelling).

Blood Supply to Brain

Artery names (anterior cerebral artery, middle cerebral artery, posterior cerebral artery, anterior choroidal artery, posterior communicating artery)
Important for understanding ischemic stroke locations.

Collateral Blood Supply to Brain

Good collateral = silent occlusion, reduced infarct extent.
No collateral = massive infarction, increased infarct size.
Clot lysis = propagation 2, necrotic brain tissue, hemorrhagic infarcts.

Multiphase CT Angiography

Used to assess collateral blood flow to brain.
Phases 1, 2, and 3 show the impact of the blockage.

Stroke Imaging

CT scanning evaluates for haemorrhage.
It may detect ischemic changes delayed (60+ minutes) and usually requires follow-up MR.

Alberta Stroke Programme Early CT Score

Evaluation of MCA (middle cerebral artery) infarct with points assigned to cortical & subcortical involvement.

Early Ischemic Changes (EIC)

CT (non-contrast) shows swelling, sulcal effacement, hypoattenuation, and loss of differentiation, loss of lentiform nucleus.
EIC response to reperfusion 1/3-2/3 of patients.
Risk of hemorrhage and evaluation of clinical outcomes.

Stroke Classification

Atherothrombosis (primary).
Small vessel disease.
Cardioembolism.
Other causes.

Middle Cerebral Artery Occlusion

Acute MCA infarction, signs of mass effect.
Old MCA infarct, 5 years later (shows lesion).

Large Artery - Atherothrombosis

Emboli originate at carotid bifurcation.
Presence of ulcers in blood vessels, causing stenosis.
Examples: arterial dissections, fibromuscular dysplasia.

Arterial Dissections

Condition with damaged vessel walls.
May involve any artery in the body, including the carotid.

Cardioembolic

Conditions causing emboli (murals thrombus, prosthetic valve, endocarditis, patent foramen ovale, valvular heart disease, atrial myxoma).

Non-Valvular Atrial Fibrillation (Risk of Stroke)

Paroxysmal, persistent, and permanent AF have varying stroke risks.

National Clinical Guideline for Stroke (UK & Ireland)

Provides clinical guidance on stroke management in the UK & Ireland.

Thrombolysis & Clot Retrieval

Time is crucial for treatment.
Optimal outcomes occur within the first few hours.
Less successful outcomes occur later in the timeframe.

Endovascular Treatment of Stroke

Techniques for treating ischemic strokes.

Small Vessel Disease

Focused on perforating vessels: end arteries, no collateral, no pressure reduction systems.
Supply critical areas: brain stem.
Common problems: design faults (Charcot-Bouchard aneurysms), lacunar infarctions.

Intracerebral Haemorrhage

Hypertension, amyloid deficits, coagulation deficits, aneurysm, AVM, cavernoma, drugs, trauma are causes.
Prevention includes controlling hypertension, coagulation issues, and avoiding drugs impacting blood clotting mechanisms.

Subarachnoid Haemorrhage

Symptoms include severe headaches and neck stiffness.
Risk factors include cigarettes and hypertension.
Caused by berry (saccular) aneurysms.

Spontaneous Subarachnoid Haemorrhage

"Worst headache".
Possible outcomes: death, coma/alert status, survive/rebleed in 4-8 days, death.

Diagnostic Process (Subarachnoid)

Initial assessment includes neuro-exam, neck stiffness, and CT scan with blood testing for subarachnoid.
Lumbar puncture (if no xanthochromia).
Angiography for determining exact cause.

Case Studies (Examples)

Patient presentations, CT results, and diagnoses.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz provides an in-depth overview of stroke, including its definitions, types, and the critical learning objectives associated with acute ischemic events. Participants will explore advances in stroke management and the importance of recognizing stroke mimics for effective treatment. Test your knowledge on stroke prevention, investigation, and rehabilitation methods.