10- Stroke

Question 1

What is the main difference between a stroke and TIA?

Answer 1

TIAs completely resolve in 24 hours

Question 2

What are the different types of strokes?

Answer 2

Ischaemic, haemorrhagic

Question 3

How long is the wondown for thrombolysis?

Answer 3

4 hours from the onset of symptoms

Question 4

Why would it make sense to do a CT before giving thrombolytics even though a stroke is strongly suggested?

Answer 4

Need to find out if ischaemic or haemorrhagic, if haemorrhagic then thrombolytics would make it much worse

Question 5

What are signs that can be seen in patient with anterior cerebral artery infarct?

Answer 5

Contralateral lower limb weakness, contralateral sensory changes in lower limb, urinary incontinence, apraxia, split brain syndrome

Question 6

why could you get urinary incontinence with an anterior cerebral artery infarct?

Answer 6

Para central lobules can be affected (found at most medial part of motor/sensory cortices)

Question 7

Why could you get alien hand or split brain syndrome in an anterior cerebral artery infarct? (very rare)

Answer 7

Blood supply to corpus callosum lost

Question 8

what is apraxia?

Answer 8

Inability to complete motor planning

Question 9

Where are the three main points in which the MCA can become occluded?

Answer 9

Proximally, the lenticulostriate arteries and more distal branches

Question 10

What signs can be seen in a patient with occlusion of their proximal (main stem before lenticulostriate branches come off) middle cerebral artery?

Answer 10

Contralateral full hemiparesis, contralateral sensory loss, visual field defects, aphasia, contralateral neglect

Question 11

Why is that although the MCA supplies the lateral aspect of the motor cortex that an occlusion there causes full hemiparesis?

Answer 11

Because the internal capsule has also been affected carrying motor fibres to lower limbs, upper limbs and face

Question 12

What visual field defect would be most likely in an MCA occlusion?

Answer 12

Contralateral homonymous hemianopia without macular sparing due to destruction of both optic radiations

Question 13

Which arteries are occluded in lacunar strokes?

Answer 13

Lenticulostriate arteries

Question 14

Small areas of destruction occur in which areas of the brain after a lacunar stroke?

Answer 14

Internal capsule, basal ganglia

Question 15

What types of lacunar strokes can be seen?

Answer 15

Pure motor, pure sensory, sensorimotor (mixed)

Question 16

Which areas of the cortex are supplied by the superior branch of the MCA, what specific areas are found here?

Answer 16

Lateral frontal lobe

Including primary motor cortex and Broca’s area

Question 17

What signs will be seen if there is occlusion of the superior division of the MCA?

Answer 17

Contralateral weakness of face and arm, expressive aphasia (if affecting left hemisphere)

Question 18

Which areas of the cerebral cortex are supplied by the inferior division of the MCA, what specific areas are found here?

Answer 18

Lateral parietal lobe and superior temporal lobe

Including the primary sensory cortex, wernicke’s area and both optic radiations

Question 19

Occlusion of the inferior division of the MCA could cause what signs?

Answer 19

Contralateral sensory changes in the face and arm, receptive (Wernicke’s) aphasia and contralateral visual field defect

Question 20

What are typical features of a posterior cerebral artery occlusion?

Answer 20

Contralateral sensory loss due to thalamus and contralateral homonymous hemianopia with macular sparing

Question 21

What are sign and symptoms seen with cerebellar artery infarcts?

Answer 21

Symptoms: nausea, vomiting, headache, vertigo/dizziness
Signs: ipsilateral DANISH and possible ipsilateral brain stem signs- contralateral sensory deficit, ipsilateral horner’s syndrome

Question 22

What is a typical feature of a brainstorm stroke?

Answer 22

Contralateral limb weakness with ipsilateral cranial nerve signs

Question 23

What are the different classifications of stroke in the the Bamford (Oxford) stroke classification?

Answer 23

TACS-total anterior circulation stroke
PACS-partial anterior circulation stroke
POCS-posterior circulation stroke
LACS-lacuna stroke