Stroke
Hypertension (severe, or with vascular disease) is a contraindication because oestrogen raises the risk of stroke and heart attack.
What our notes say
- Hypertension (severe, or with vascular disease) is a contraindication because oestrogen raises the risk of stroke and heart attack. (Junior Clerkship in Reproductive Health (MBOG 4200): end of year examination, 4 )
- CHA2DS2-VASc is at least 4 (age 65 to 74, female, hypertension, LV dysfunction), so anticoagulation is needed to prevent stroke from left atrial thrombus, and before and for 4 weeks after cardioversion. (Clinical Pharmacology I (MBPL 4400) main exam: 25 January 2023)
- Aspirin (with a statin and blood pressure control) is the standard secondary prevention for an ischaemic stroke. (Internal Medicine (MBIM 4100) special/supplementary exam, Paper Two: 14 August 2)
- Physical → mental: chronic illness (HIV, diabetes, cancer, stroke), pain, and disability raise the rate of depression and anxiety; some medicines (steroids, efavirenz, isoniazid) cause psychiatric effects. (Psychiatry, Sociology, Anthropology and Psychology)
- | Neurological | Stroke (especially right hemisphere), traumatic brain injury, frontal or temporal tumours, multiple sclerosis, epilepsy (temporal lobe), Huntington's, Wilson's disease, neurosyphilis, HIV-associated neurocognitive disorder | (Bipolar and Related Disorders)
- [ ] Secondary causes: thyroid, steroids, khat, HIV, syphilis, stroke, efavirenz, isoniazid (Bipolar and Related Disorders)
Study material on Stroke
- Cerebrovascular Disease: Stroke, Ischemia & Hemorrhage Explained
- Cerebrovascular Disease: Stroke, Ischemia & Hemorrhage Explained
- Cardiovascular system examination revised 2012
- Internal Medicine (MBIM 4100) main exam, Paper One: 3 July 2019
- Medical Physiology Assorted SAQs — With Answers (Past Paper Study Guide)
- Internal Medicine (MBIM 4100) special/supplementary exam, Paper Two: 14 August 2019
- 🫀 VALVULAR HEART DISEASE — ULTRA DEEP NOTES
- Epidemiology And Biostatistics
- CARDIOVASCULAR PATHOLOGY
- Sickle Cell Disease: Pathology, Genetics & Mechanisms
- Cardiovascular Pathology MCQs
- Weekly Pathology Exam - October 9, 2026 (Section A: MCQs)
- Weekly Pathology Exam - September 25, 2026 (Section A: MCQs)
- Weekly Pathology Exam - September 11, 2026 (Section A: MCQs)
- Weekly Pathology Exam - September 4, 2026 (Section A: MCQs)
- Weekly Pathology Exam - August 28, 2026 (Section A: MCQs)
Practice questions on Stroke
A 45-year-old woman has orthopnea, dysphagia, and a prior stroke. CXR shows near-normal LV but prominent left atrial border. What is the most likely condition?
- Aortic stenosis
- Mitral regurgitation
- Mitral stenosis
- Tricuspid stenosis
Answer: C. A prominent left atrial border on CXR is indicative of left atrial enlargement. In the context of orthopnea and dysphagia (potentially due to enlarged left atrium pressing on the esophagus), mitral stenosis is a strong possibility, leading to left atrial dilation.
A 49-year-old woman with poorly controlled atrial fibrillation dies after a stroke. Autopsy shows fused mitral leaflets, shortened chordae, and thrombus-filled enlarged left atrium. What is the most likely underlying cause?
- Rheumatic heart disease
- Hypertrophic cardiomyopathy
- Dilated cardiomyopathy
- Infective endocarditis
Answer: A. The findings of fused mitral leaflets, shortened chordae, left atrial enlargement, and thrombus formation are highly characteristic of chronic rheumatic heart disease, a sequela of rheumatic fever, which predisposes to atrial fibrillation and thromboembolic events.
A 45-year-old woman has orthopnea, dysphagia, and a prior stroke. CXR shows near-normal LV but prominent left atrial border. Most likely condition?
- Mitral stenosis
- Aortic regurgitation
- Mitral regurgitation
- Tricuspid stenosis
Answer: A. Orthopnea and a prominent left atrial border on CXR are suggestive of left atrial enlargement. Dysphagia can be caused by an enlarged left atrium compressing the esophagus. Mitral stenosis is the most common cause of significant left atrial enlargement and often leads to these symptoms. A prior stroke is a risk factor for atrial fibrillation, which can be associated with mitral valve disease.
A 49-year-old woman with poorly controlled atrial fibrillation dies after a stroke. Autopsy shows fused mitral leaflets, shortened chordae, and thrombus-filled enlarged left atrium. Most likely underlying cause?
- Rheumatic heart disease
- Degenerative mitral valve disease
- Infective endocarditis
- Congenital mitral valve anomaly
Answer: A. Fused mitral leaflets, shortened chordae, left atrial enlargement, and atrial fibrillation are classic findings of chronic rheumatic heart disease. It is a common cause of mitral valve disease and predisposes to atrial fibrillation and embolic strokes.
A 45-year-old woman has orthopnea, dysphagia, and a prior stroke. CXR shows near-normal LV but prominent left atrial border. What is the most likely condition?
- Aortic regurgitation
- Mitral stenosis
- Tricuspid regurgitation
- Pulmonic stenosis
Answer: B. Orthopnea and a prominent left atrial border on CXR, especially in a patient with a history of stroke (which can increase risk of cardiac issues) and dysphagia (sometimes associated with left atrial enlargement), strongly suggest mitral stenosis. The enlarged left atrium is a hallmark of this condition due to backing up of blood from the left ventricle.
A 49-year-old woman with poorly controlled atrial fibrillation dies after a stroke. Autopsy shows fused mitral leaflets, shortened chordae, and thrombus-filled enlarged left atrium. What is the most likely underlying cause?
- Rheumatic heart disease
- Hypertrophic cardiomyopathy
- Dilated cardiomyopathy
- Ischemic heart disease
Answer: A. Fused mitral leaflets and shortened chordae are characteristic pathological findings of rheumatic heart disease, a sequela of recurrent streptococcal infections. This can lead to significant mitral valve dysfunction, left atrial enlargement, thrombus formation, and an increased risk of embolic stroke, especially in the context of atrial fibrillation.