16) Stroke

Question 1

What is a stroke?

Answer 1

Damaging or killing of brain cells starved of oxygen

Question 2

What is a TIA?

Answer 2

Stroke that recovers within 24 hours of the onset of symptoms

Question 3

What is stroke syndrome?

Answer 3

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

Question 4

What are the two main types of stroke?

Answer 4

Ischaemic (85%)

Hemorrhagic (10%)

Question 5

What are some other causes of stroke (not the main two)?

Answer 5

Dissection and venous sinus thrombosis

Question 6

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

Answer 6

Contralateral lower limb motor signs, initially flaccid paralysis followed by spasticity.
Contralateral loss of all sensory modalities in lower limb
Incontinence (paracentral lobules)
Split brain/alien hand syndrome (corpus callosum)

Question 7

How would a patient with a proximal middle cerebral artery stroke present? (sensory and motor)

Answer 7

Considerable cerebral oedema -> RICP -> coma
Contralateral motor signs in upper limb and face, spasticity, contralateral sensory loss in all modalities
Proximal can affect internal capsule so lower limb signs too

Question 8

How would a patient with a middle cerebral artery stroke in the non dominant hemisphere present?

Answer 8

Hemispatial neglect
Tactile extinction
Visual extinction
Anosognosia

Question 9

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

Answer 9

Contralateral homonymous hemianopia with macular sparing

Question 10

How would a patient with a cerebellar artery stroke present?

Answer 10

Ipsilateral signs - loss of coordination, precision and timing of movement
DANISH
If proximal - brainstem signs too

Question 11

How would a patient with a proximal basilar artery stroke present?

Answer 11

Locked in syndrome

Question 12

How would a patient with a distal basilar artery stroke present?

Answer 12

Bilateral occipital lobe infarction (cortical blindness)
Bilateral thalamic infarction
Bilateral midbrain involvement

Question 13

What are some risk factors for lacunar strokes?

Answer 13

Diabetes, HTN, smoking

Question 14

What arteries would be affected in a pure motor stroke?

Answer 14

Lenticulostriate arteries supplying posterior limb of internal capsule

Question 15

What arteries would be affected in a pure sensory stroke?

Answer 15

Thalamoperforator artery (PCA)

Question 16

List the OSCP classification of strokes:

Answer 16

Total anterior circulation syndrome
Partial anterior circulation syndrome
Posterior circulation syndrome
Lacunar syndrome

Question 17

Which artery is likely to be affected in total anterior circulation syndrome?

Answer 17

Proximal MCA or ICA

Question 18

Which artery is likely to be affected in partial anterior circulation syndrome?

Answer 18

Branch MCA occlusion

Question 19

Which arteries are likely to be affected in posterior circulation syndrome?

Answer 19

Vertebral, basilar, cerebellar or PCA

Question 20

What are the subtypes of lacunar syndrome strokes?

Answer 20

Pure motor, pure sensory, sensorimotor, ataxic hemiparesis, clumsy hand

Question 21

What may be seen on a CT scan in a stroke patient?

Answer 21

Direct visualisation of clot (hyperdense artery)

Grey matter darkening (hypodense)

Question 22

What are some stroke mimics?

Answer 22

Hypoglycemia, epilepsy, migraine, intracranial tumour/infection

Question 23

Describe the management of a stroke patient:

Answer 23

CT - rule out haemorrhage
Thrombolysis - within 4.5 hours and no CIs
Aspirin, statin
Stroke unit - swallow, physio, review

Question 24

What additional effects could a MCA stroke lead to?

Answer 24

Contralateral homonymous hemianopia (proximal) or contralateral quadrantanopia (distal)
Global, Broca’s or Wernicke’s aphasia