10.1 Stroke

Question 1

define stroke

Answer 1

serious life threatening condition occurring when blood supply to brain is cut off, signs and symptoms last more than 24 hours

Question 2

emergency management of stroke

Answer 2

-CT/MRI to see if there’s a bleed
-if no bleed, and within 4 hours = thrombolysis

Question 3

explain why ACA infarct could lead to urinary incontinence

Answer 3

ACA supplies paracentral lobules of motor and sensory cortices, which supply perineal area.

so less of control

Question 4

explain why ACA infarct could lead to apraxia

Answer 4

ACA supplies left frontal lobe, so leads to ineffective motor planning

Question 5

what type of motor loss is seen in proximal MCA infarct?

Answer 5

contralateral full hemiparesis, as internal capsule fibres mixed to leg, arm and fa ce

Question 6

what type of visual loss is seen in proximal MCA infarct? why?

Answer 6

contralateral homonymous hemianopia without macular sparing, as both inferior and superior optic radiations (temporal and parietal lobes) destroyed

Question 7

what type of visual loss is seen in distal MCA infarct? why?

Answer 7

quadranatopia, as maybe only superior OR inferior optic radiations affected

Question 8

how to distinguish lenticulostriate infarct from others

Answer 8

no cortical features e.g. neglect, aphasia

Question 9

types of lacunar strokes

Answer 9

pure motor
-IC motor fibres affected

pure sensory
-IC sensory fibres affected

sensorimotor
-boundary between motor and sensory fibres IC

Question 10

features of distal MCA stroke, superior division

Answer 10

lateral frontal lobe affected
-contralateral face, arm weakness, expressive (Broca’s) aphasia if L

Question 11

features of distal MCA stroke, inferior division

Answer 11

lateral parietal lobe, superior temporal

-contrlateral sensory change face, arm
-receptive (wernicke’s) aphasia if L
-contralateral homonymous hemianopia without macular sparing

Question 12

PCA stroke features

Answer 12

-contralateral homonymous hemianopia with macular sparing (collateral supply from MCA)

-contralateral sensory loss due to thalamus damage

Question 13

cerebellar infarct features

Answer 13

-ipsilateral cerebella signs: DANISH
-ipsilateral CN signs
-ipsilateral Horner’s

Question 14

why does cerebellar infarct cause ipsilateral Horner’s?

Answer 14

sympathetic pathways descend in brainstem to spinal cord, and cerebellar arteries normally supply brainstem as they loop round cerebellum

Question 15

features of distal basilar artery occlusion

Answer 15

-visual and cocculomotor deficits
-behavioural abnormalities
-somnolencde, hallucinations, dreamlike (as brainstem contains reticular activating system importune for consciousness)

Question 16

why is motor function often OK in distal (superior) basilar artery occlusion)?

Answer 16

cerebral peduncles can et blood from PCAs in turn from posterior communicating arteries

Question 17

features of proximal basilar artery occlusion

Answer 17

locked in syndrome
bilateral pontine branches occluded

-eyes move OK as midbrain supply from PCAs
-preserved consciousness as midbrain reticular formation intact

Question 18

Total Anterior Circulation Syndrome

Answer 18

hemiparesis+

higher cortical dysfunction+

homonymous hemianopia

Question 19

Partial Anterior Circulation Syndrome

Answer 19

hemiparesis+

homonymous hemianopia

OR

higher cortical dysfunction

Question 20

POsterior Circualtion Syndrome

Answer 20

isolated hemianopia

or

cerebellar syndromes

Question 21

what type of stroke is basilar artery occlusion?

Answer 21

POCS

Question 22

what type of stroke is brainstem stroke?

Answer 22

POCS

Question 23

what type of stroke is cerebellar infarct?

Answer 23

POCS

Question 24

what type of stroke is PCA infarct?

Answer 24

POCS

Question 25

what type of stroke is distal MCA occlusion

Answer 25

PACS

Question 26

what type of stroke is lenticulostriate occlusion?

Answer 26

LACS

Question 27

what type of stroke is proximal MCA occlusion?

Answer 27

TACS