10- Stroke Flashcards
What is the main difference between a stroke and TIA?
TIAs completely resolve in 24 hours
What are the different types of strokes?
Ischaemic, haemorrhagic
How long is the wondown for thrombolysis?
4 hours from the onset of symptoms
Why would it make sense to do a CT before giving thrombolytics even though a stroke is strongly suggested?
Need to find out if ischaemic or haemorrhagic, if haemorrhagic then thrombolytics would make it much worse
What are signs that can be seen in patient with anterior cerebral artery infarct?
Contralateral lower limb weakness, contralateral sensory changes in lower limb, urinary incontinence, apraxia, split brain syndrome
why could you get urinary incontinence with an anterior cerebral artery infarct?
Para central lobules can be affected (found at most medial part of motor/sensory cortices)
Why could you get alien hand or split brain syndrome in an anterior cerebral artery infarct? (very rare)
Blood supply to corpus callosum lost
what is apraxia?
Inability to complete motor planning
Where are the three main points in which the MCA can become occluded?
Proximally, the lenticulostriate arteries and more distal branches
What signs can be seen in a patient with occlusion of their proximal (main stem before lenticulostriate branches come off) middle cerebral artery?
Contralateral full hemiparesis, contralateral sensory loss, visual field defects, aphasia, contralateral neglect
Why is that although the MCA supplies the lateral aspect of the motor cortex that an occlusion there causes full hemiparesis?
Because the internal capsule has also been affected carrying motor fibres to lower limbs, upper limbs and face
What visual field defect would be most likely in an MCA occlusion?
Contralateral homonymous hemianopia without macular sparing due to destruction of both optic radiations
Which arteries are occluded in lacunar strokes?
Lenticulostriate arteries
Small areas of destruction occur in which areas of the brain after a lacunar stroke?
Internal capsule, basal ganglia
What types of lacunar strokes can be seen?
Pure motor, pure sensory, sensorimotor (mixed)
Which areas of the cortex are supplied by the superior branch of the MCA, what specific areas are found here?
Lateral frontal lobe
Including primary motor cortex and Broca’s area
What signs will be seen if there is occlusion of the superior division of the MCA?
Contralateral weakness of face and arm, expressive aphasia (if affecting left hemisphere)
Which areas of the cerebral cortex are supplied by the inferior division of the MCA, what specific areas are found here?
Lateral parietal lobe and superior temporal lobe
Including the primary sensory cortex, wernicke’s area and both optic radiations
Occlusion of the inferior division of the MCA could cause what signs?
Contralateral sensory changes in the face and arm, receptive (Wernicke’s) aphasia and contralateral visual field defect
What are typical features of a posterior cerebral artery occlusion?
Contralateral sensory loss due to thalamus and contralateral homonymous hemianopia with macular sparing
What are sign and symptoms seen with cerebellar artery infarcts?
Symptoms: nausea, vomiting, headache, vertigo/dizziness
Signs: ipsilateral DANISH and possible ipsilateral brain stem signs- contralateral sensory deficit, ipsilateral horner’s syndrome
What is a typical feature of a brainstorm stroke?
Contralateral limb weakness with ipsilateral cranial nerve signs
What are the different classifications of stroke in the the Bamford (Oxford) stroke classification?
TACS-total anterior circulation stroke
PACS-partial anterior circulation stroke
POCS-posterior circulation stroke
LACS-lacuna stroke
