11.4 Stroke

Question 1

What are the symptoms and signs of stroke?

Answer 1

Headache
Acute onset of neurological symptoms: dizziness or balance disturbance, visual, hearing, speech or language abnormalities, muscle weakness or incoordination, swallow disturbance
Altered consciousness

Question 2

What are the DD for stroke

Answer 2

Intracranial tumour or infection 
Seizure 
Demyelination 
Non occlusive, non haemorrhagic cerebrovascular disorder, hypoglycaemia 
Psychiatric disorder

Question 3

What determines the symptoms?

Answer 3

Location and size of occluded blood vessel
Duration of occlusion
Potential for collateral blood supply

Question 4

What is the normal blood flow and at what level will you see deficits?

Answer 4

Normal is 50-60ml/100g/min but the brain can cope with down to 20
10-20 you will have symptoms - stroke evolution, TIA and reversible ischaemic deficit

Question 5

What is the infarct core and penumbra?

Answer 5

Core = region where the artery supplies and this region will die

Penumbra = area around the core where there is enough collateral blood supply so the function will decrease but not die - there will be symptoms but these can be reversed - this is the area that you really want to save

Question 6

What are the causes of arterial occlusion and the risk factors?

Answer 6

Atherosclerosis: hypertension, hyperlipidemia, obesity, smoking, diabetes
Cardiac thromboembolism: atrial fibrillation, MI, cardiac valvular lesion, endocarditis
Pro-coagulant state: Protein C or S def, prothrombin G mutation, antithrombin III def, OCP
Arterial injury: penetrating injury, arterial dissection
Iatrogenic: invasive procedures

Question 7

What are the causes of intracranial haemorrhage?

Answer 7

Vascular morphology: AV malformation, arteriovenous fistulaem cavernous malformation
Vascular micropathology: hyaline arteriosclerosis, amyloid angiopathy
Impaired coagulation
Hypertension

Question 8

What is the presentation of a middle cerebral artery occlusion?

Answer 8

Face/arm weakness on C/L side, relative sparing of teh leg

Global aphasia if dominant hemisphere

Question 9

What is the presentation of a anterior cerebral artery occlusion?

Answer 9

C/L leg weakness/numbness (may involve face/arm if recurrent artery), may have incontinence

Question 10

What is the presentation of posterior cerebral artery occlusion?

Answer 10

Cortical homonymous hemianopia, macular sparing
Memory impairment if significant temporal lobe envolvement
Alexia if dominant hemisphere
Webers syndrome (C/L hemiplegia) if proximal

Question 11

What will you get in a Basilar artery occlusion?

Answer 11

Loss of consciousness or locked in syndrome

Gaze abnormalities, facial anasthesia

Question 12

What will you get with vertebral artery/PICA occlusion?

Answer 12

Dizziness, ataxia on I/L side (cerebellar)

Lateral medullary syndrome