Podcast
Questions and Answers
What does the 'S' in the acronym STROKE represent?
What does the 'S' in the acronym STROKE represent?
Which factor is considered a non-modifiable risk factor for stroke?
Which factor is considered a non-modifiable risk factor for stroke?
What is the correct classification of stroke as defined in the learning outcomes?
What is the correct classification of stroke as defined in the learning outcomes?
How much of stroke cases are considered preventable according to the information provided?
How much of stroke cases are considered preventable according to the information provided?
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What is one myth about stroke that is addressed?
What is one myth about stroke that is addressed?
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What is indicated as an important aspect of managing stroke risk factors?
What is indicated as an important aspect of managing stroke risk factors?
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What type of headache is associated with stroke, as indicated by the acronym STROKE?
What type of headache is associated with stroke, as indicated by the acronym STROKE?
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At what age does the risk of stroke increase significantly?
At what age does the risk of stroke increase significantly?
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What is the primary cause of stroke in individuals under 40 years old?
What is the primary cause of stroke in individuals under 40 years old?
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Which of the following factors is considered the most significant modifiable risk for stroke?
Which of the following factors is considered the most significant modifiable risk for stroke?
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What was the approximate number of stroke deaths worldwide in 2020?
What was the approximate number of stroke deaths worldwide in 2020?
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Which demographic has a declining incidence of stroke due to better health management?
Which demographic has a declining incidence of stroke due to better health management?
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What percentage of deaths in the United States was accounted for by stroke in 2020?
What percentage of deaths in the United States was accounted for by stroke in 2020?
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What condition is known to increase the chance of stroke by four times?
What condition is known to increase the chance of stroke by four times?
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What is the average time interval for a stroke death to occur in the United States as of 2020?
What is the average time interval for a stroke death to occur in the United States as of 2020?
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Which type of stroke accounted for the highest number of deaths in 2020?
Which type of stroke accounted for the highest number of deaths in 2020?
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What is the primary structural abnormality associated with a brain arteriovenous malformation (AVM)?
What is the primary structural abnormality associated with a brain arteriovenous malformation (AVM)?
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Which of the following statements regarding MoyaMoya disease is accurate?
Which of the following statements regarding MoyaMoya disease is accurate?
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What is a potential consequence of intracerebral hemorrhage (ICH)?
What is a potential consequence of intracerebral hemorrhage (ICH)?
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Which of the following guidelines is NOT recommended for stroke prevention?
Which of the following guidelines is NOT recommended for stroke prevention?
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Which professional is NOT typically part of a stroke team?
Which professional is NOT typically part of a stroke team?
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What percentage of patients die or become permanently disabled from the initial event of a stroke according to the provided information?
What percentage of patients die or become permanently disabled from the initial event of a stroke according to the provided information?
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What is a common risk associated with smoking in terms of stroke?
What is a common risk associated with smoking in terms of stroke?
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If a patient is diabetic, what is the best approach to reduce their stroke risk?
If a patient is diabetic, what is the best approach to reduce their stroke risk?
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Which population has the highest overall rates of stroke mortality?
Which population has the highest overall rates of stroke mortality?
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What is the leading cause of ischemic stroke mortality in Eastern Europe?
What is the leading cause of ischemic stroke mortality in Eastern Europe?
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What percentage of stroke survivors experience some form of neurological impairment or disability?
What percentage of stroke survivors experience some form of neurological impairment or disability?
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In which age group is non-traumatic subarachnoid hemorrhage most common?
In which age group is non-traumatic subarachnoid hemorrhage most common?
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What condition significantly increases the risk of developing an ischemic stroke?
What condition significantly increases the risk of developing an ischemic stroke?
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What is the most common type of stroke accounting for approximately 80% of cases?
What is the most common type of stroke accounting for approximately 80% of cases?
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What underlying issue primarily causes intracerebral hemorrhage?
What underlying issue primarily causes intracerebral hemorrhage?
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What is one of the major consequences of experiencing a transient ischemic attack (TIA)?
What is one of the major consequences of experiencing a transient ischemic attack (TIA)?
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Which factor is NOT a non-modifiable risk factor for ischemic stroke?
Which factor is NOT a non-modifiable risk factor for ischemic stroke?
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What percentage of stroke patients may experience a recurrent stroke within five years?
What percentage of stroke patients may experience a recurrent stroke within five years?
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Study Notes
Clinical Sciences: Medical and Neurological Conditions - Cerebral Vascular Accident (CVA) / Stroke A
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Learning Outcomes:
- Understand the epidemiology of CVA in Hong Kong
- Identify different types of CVA
- Recognize the clinical features and pathology of CVA
- Learn about the general medical management of CVA
Outline of Lecture
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Epidemiology:
- Definition of CVA
- Types and Pathology
- Signs and Symptoms
- Classifications
- Clinical Features
- Medical Managements
What is Stroke?
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Symptoms:
- Speech problems
- Tingling or numbness in the body
- Problems with thinking
- Loss of balance or coordination problems
- Severe headache
- Vision problems
Stroke: It's NOT an "Accident"
- CVA is a poor term
- Stroke is preventable and treatable
- Prevention is better than cure
- Combating stroke decreases medical costs
The Perceptions of Stroke
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Myths:
- Stroke is not preventable
- Stroke cannot be treated
- Stroke only strikes the elderly
- Stroke happens in the heart
- Stroke recovery ends after 6 months
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Reality:
- Up to 80% of strokes are preventable
- Stroke requires emergency treatment
- Anyone can have a stroke
- Stroke is a "Brain Attack"
- Stroke recovery can last a lifetime
Risk Factors of Stroke
- Family history of stroke
- Age over 55 (risk increases with age)
- High blood pressure
- High cholesterol (atherosclerosis)
- Cigarette smoking
- Diabetes mellitus
- Obesity
- Cardiovascular disease
- Vascular malformation or aneurysm
- Alcohol consumption
Epidemiology
- 12.2 million new strokes annually globally
- One stroke every 3 seconds
- 101 million people globally live with stroke aftermath
- This number doubled over the last 30 years
- In 2019, 63% of strokes occurred in people under 70 years old.
- Stroke is no longer solely a disease of the elderly.
Epidemiology WHO 2016
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Top 10 global causes of deaths:
- Ischemic heart disease
- Stroke
- Chronic obstructive pulmonary disease
- Lower respiratory infections
- Alzheimer's disease and other dementias
-
Top 10 causes of deaths in low-income, upper-middle, and high-income countries.
Epidemiology in Hong Kong
- Stroke was the fourth leading cause of death in Hong Kong in 2020
- 3,164 registered deaths
How Stroke Survivors Suffer?
- 2/3 experience neurological impairment and disability
- 15% institutionalized within 5 years
- 20% experience recurrent stroke
- 22.5% experience dementia
Definition Of Cerebral Vascular Accident (CVA)
- Rapidly developing clinical signs of focal or global disturbance of cerebral function
- Symptoms last 24 hours or longer or lead to death
- No apparent cause other than vascular origin
- Sudden brain dysfunction due to blood vessel problems
- Transient Ischemic Attack (TIA) is less than 24 hours
Classification of CVA
- Ischemic Stroke (Infarction): ~80%
- Hemorrhagic stroke: ~20%
- Transient Ischemic Attack (TIA)
Pathology - Ischemic Stroke
- Diminished blood supply to focal area of brain
- Mostly thromboembolism
Pathology - Sub-type of Infarction
- Thromboembolism: Blood clot forms in the vascular system
- Thrombotic Infarction: Clot develops in the brain artery itself
- Embolic Infarction: Clot travels from another site (e.g., heart)
- Large blood vessel
Ischemic Stroke Risk Factors (Non-Modifiable)
- Advanced age
- Male gender
- Race (Asian, Black)
- Family history of MI or early stroke
Ischemic Stroke Risk Factors (Modifiable)
- Hypertension (systolic and diastolic)
- Diabetes mellitus
- Hypercholesterolemia
- Cigarette smoking
- Prior stroke or TIA
- Carotid disease, heart disease
- Hypercoagulable states
- Cocaine, excessive alcohol use
Pathology - Hemorrhagic Stroke (Intracerebral Hemorrhage (ICH))
- Blood vessel rupture within the skull (not due to trauma)
- Due to chronic arteriolar hypertensive disease(HT)
- Preventing blood flow to the brain
- Higher incidence in Asian patients (15-30%)
- Higher mortality than ischemic stroke
Pathology - Subarachnoid Hemorrhage (SAH)
- Rupture of aneurysms at the bifurcations of large arteries at the inferior surface of the brain
- Vessel malformation and tumors
- Non-traumatic subarachnoid hemorrhage (Most common in 40-60 year-old people)
- Female: male ratio of 2:1
- Smoking increases risk 3-10 times
Pathology - Brain Arteriovenous Malformation (AVM)
- Abnormal blood vessels connecting arteries and veins in the brain
- Usually congenital(at birth) in origin and onset in the 20s - 30s
Pathology - TIA (Transient Ischemic Attack)
- Transient blockage of a cerebral artery
- Decreasing blood flow to the brain
- Many strokes result from complete blockage leading to brain cell death and permanent loss of function
How to Investigate & Make Diagnosis for Stroke
- Computerized Tomography (CT Scan): Differentiate stroke (lack of blood supply) from hemorrhagic stroke (bleeding).
- Magnetic Resonance Imaging (MRI): Shows the status of brain tissue and the patency/narrowing of blood vessels.
- Ultrasonic Imaging of Cervical Blood Vessels: Detects narrowing or blockage in the neck's blood vessels
- Transcranial Doppler (TCD): Detects narrowing or blockages in the brain's blood vessels
CT Scan
- Infarction: Hypodense (darker) areas.
- Hemorrhage: Hyperdense (lighter) areas
Magnetic Resonance Image (MRI)
- Different sequences (e.g., T1, T2, FLAIR) provide additional information
- Helps in evaluating the severity and location of stroke-related issues like hematomas.
Magnetic Resonance Angiography (MRA)
- Specialized MRI to visualize blood vessels and identify abnormalities.
Review of Brain Vessels
- Diagram of the major arteries supplying blood to the brain and surrounding areas
Blood supply to Different Areas
- Diagram illustrating the branches of the major arteries supplying different brain regions
Review of Brain Structure & Function
- Diagram of the brain with labeled functional areas.
Classification of CVA - By Types
- Cerebral ischemic stroke: Acute focal neurological dysfunction from a single or multiple brain/retina infarcts, lasting more than 24 hours.
- Intracerebral hemorrhage: Hemorrhage within the brain parenchyma or ventricular system, causing neurological dysfunction.
- Subarachnoid hemorrhage: Hemorrhage in the subarachnoid space, primarily due to aneurysm rupture.
- Stroke of unknown type: When a stroke has occurred but determining if ischemic vs. hemorrhagic has not been accomplished through diagnostic testing
Clinical Features
-
Hemorrhagic Stroke (general):
- Sudden onset & dramatic headache (worst of their life)
- Visual Disturbances
- Nausea and Vomiting
- Neck and back pain
- Sensitivity to light
- Weakness on one side
-
Ischemic Stroke (general):
- Hard to detect as a first sign, gradual or subtle development
- Weakness in one side of the body
- Facial drooping
- Numbness and tingling
- Language disturbances
- Visual disturbances
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Left Brain Stroke:
- Right side paralysis
- Speech and language disturbances
- Behavioral changes
- Swallowing issues
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Right Brain Stroke:
- Left side paralysis
- Spatial perception issues
- Coordination problems
- Perception & recognition of familiar objects
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Neurological Complications:
- Brain edema
- Hemorrhagic transformation
- Seizures/epilepsy
- Recurrent stroke
- Delirium/vascular dementia
Medical Assessment
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Initial Assessment:
- General impression
- Airway management
- High-flow O2
- Circulation check
- High-priority transport
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Further Medical Assessment (AED):
- Focused history and physical exam, Including a thorough neurologic exam
- History of seizures, headaches, nausea/vomiting, neck pain
- Obtain baseline vitals
- Recheck vitals frequently
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Priorities of Care:
- Trauma assessment (recent or within the last month)
- Assess for recent seizures or subdural hematoma
- Cardiovascular status: cardiac medications, atrial fibrillation, blood thinners (e.g., Warfarin)
- Pulse oximetry (>94% SpO2)
- Blood sugar control
- Pupil assessment
Stroke Prevention Guidelines
-
Awareness of blood pressure:
- Normal BP
- Elevated BP (pre-hypertension)
- High Blood Pressure (Hypertension) - Stage1
- High Blood Pressure (Hypertension) - Stage 2
- Hypertensive Crisis - consult a doctor immediately
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Prevention Considerations:
- Recognizing and managing atrial fibrillation
- Avoiding excessive alcohol intake
- Managing cholesterol if affected
- Controlling diabetes carefully
- Exercise regularly
- Maintaining a low-sodium and low-fat diet
- Seeking medical attention for any circulation issues
- Contacting emergency services (911 or 999 in HK) for immediate Stroke symptoms
Stroke Team
- Stroke Physician
- Neurologist
- Nurses
- Physiotherapist
- Occupational therapist
- Speech therapist
- Pharmacist
- Dietitian
- Social worker
- Clinical psychologist
Useful Web Sources (Local & International)
- Provides links to various stroke-related organizations and resources in Hong Kong and internationally
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Description
Test your knowledge on the different aspects of stroke, including risk factors, preventability, and common myths. This quiz covers essential information that can help in stroke awareness and management. Perfect for healthcare professionals and anyone interested in understanding stroke better.
