12. Stroke

Question 1

What is a stroke?

Answer 1

The damaging or killing of brain cells starved of oxygen as a result of the blood supply to part of the brain being cut off.

Question 2

What is a transient ischaemic attack (TIA)?

Answer 2

A stroke that recovers within 24 hours from the onset of symptoms.

Question 3

What is stroke syndrome?

Answer 3

A constellation of signs and symptoms produced due to occlusion or damage of an artery supplying part of the brain.

Question 4

Name 2 causes of stroke in young patients.

Answer 4

Vasculitis.
Sickle cell anaemia.
Cocaine.

Question 5

What are the 2 main places a blood clot comes from to cause a stroke?

Answer 5

The carotid arteries - join the circle of Willis.

The heart eg due to AF or valvular disease/prosthetic valves.

Question 6

How does a patient with an anterior cerebral artery stroke present?

Answer 6

Motor - contralateral lower limb flaccid paralysis followed later by spasticity. Can have unitary incontinence if affects the paracentral lobules, and split brain syndrome or alien hand syndrome if the corpus callous is damaged.
Sensory - contralateral loss of all sensory modalities in the lower limb.

Question 7

How does a patient with a middle cerebral artery stroke present?

Answer 7

Motor - contralateral upper limb and face flaccid paralysis followed by spasticity.
Sensory - contralateral loss of all sensory modalities in the upper limb and face.

Question 8

How does a patient with a posterior cerebral artery stroke present?

Answer 8

Contralateral homonymous hemianopia with macular sparing.

Question 9

How does a patient with a cerebellar artery stroke present?

Answer 9

Dysdiadochokinesia.
Ataxia.
Nystagmus.
Intention tremor.
Slurred speech.
Hypotonia.