10. Stroke

Question 1

What is the definitions of a stroke?

Answer 1

A neurological deficit attributed to an acute focal injury of the CNS by a vascular cause

Question 2

What is the definition of TIA?

Answer 2

A transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without cute infarction

Question 3

What are the signs of an anterior cerebral artery infarct?

Answer 3

Contralateral weakness in lower limb (lower limbs affected more than upper limb and face)
Contralateral sensory changes - lower limb
Urinary incontinence
Split brain syndrome
Frontal lobe features - apraxia, aphasia

Question 4

What are the signs in a proximal MCA occlusion?

Answer 4

Contralateral hemiparesis
Contralateral sensory deficit
Contralateral homonomous hemianopia
If left sided, aphasia
If right sided, contralateral hemispatial neglect

Question 5

Where do lacunar strokes (lenticulostriate arteries occluded) affect?

Answer 5

Cause destruction of small areas of internal capsule and basal ganglia

Question 6

What are the types of lacunar strokes?

Answer 6

Pure motor
Pure sensory
Sensorimotor

Question 7

What does MCA occlusion in superior division cause?

Answer 7

Contralateral face and arm weakness and expressive aphasia if left hemisphere affected
Can affect primary motor cortex and Broca’s area

Question 8

What does occlusion in inferior division of MCA cause?

Answer 8

Problems with primary sensory cortex, wernicke’s area and both optic radiations
Occlusion will cause contralateral sensory change in face and arm, receptive aphasia if contralateral visual field defect without macular sparing

Question 9

What are the signs of PCA stroke?

Answer 9

Somatosensory and visual dysfucntion
Contralateral homonomous hemianopia with macular sparing
Contralateral sensory loss due to damage to thalamus

Question 10

What are the symptoms of cerebellar infarcts?

Answer 10

Nausea
Vomiting
Headache
Vertigo/dizziness

Question 11

What are the ipsilateral cerebellar signs?

Answer 11

Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia

Question 12

What are the general signs of cerebellar infarcts?

Answer 12

Ipsilateral cerebellar signs
Possible ipsilateral brainstem signs
Possible contralateral sensory deficit/ipsilateral Horner’s

Question 13

Why can basilar artery occlusion lead to sudden death?

Answer 13

This vessel supplies the brainstem which contains many vital centres

Question 14

What signs can basilar artery occlusion cause?

Answer 14

Visual and oculomotor deficits
Behavioural abnormalities
Somnolence, hallucinations and dreamlike behaviour
Motor dysfunction often absent

Question 15

What can a proximal basilar occlusion cause?

Answer 15

Locked in syndrome
Complete loss of movement of limbs however preserved ocular movement
Preserved consciousness

Question 16

What are TACS?

Answer 16

Total anterior circulation strokes

All 3 of: unilateral weakness of face, arm and leg, homonymous hemianopia, higher cerebral dysfunction

Question 17

What are POCS?

Answer 17

Posterior circulation stroke
Only need one of the following: cranial nerve palsy and contralateral motor/sensory deficit, bilateral motor/sensor deficit, conjugate eye movement disorder, cerebellar dysfunction, isolated homonymous hemianopia (with macular sparing)

Question 18

What are LACS?

Answer 18

Lacunar strokes

One of the following: pure sensory deficit, pure motor deficit, sensorimotor deficit, ataxic hemiparesis

Question 19

What is a typical feature of brainstem strokes?

Answer 19

Contralateral limb weakness is seen with ipsilateral cranial nerve signs