9.1: Strokes

Question 1

Are most stroke haemorrhagic or ischaemic?

Answer 1

85% ischaemic

10% haemorrhagic

Question 2

What does the anterior cerebral artery supply?

Answer 2

Medial portion of the frontal and parietal lobes and corpus callosum

Question 3

If the left ACA was affected by a stroke, what symptoms would this cause?

Answer 3

Sensory and motor cortexes affected
Lower limb part of homonculus affected
Hence right hand sided sensory and motor loss
Also incontinence (as this is the most medial part of the homonculus)

Corpus callosum affected
Hence split brain syndrome and alien hand syndrome

Question 4

What areas of the brain does the middle cerebral artery supply?

Answer 4

Lateral aspect of frontal and parietal lobes and internal capsule
Hence supplies upper limb and face part of homonculus

Question 5

How would a patient with a stroke affecting the middle cerebral artery present?

Answer 5

Symptoms on left hand side
Upper limb and face sensory and motor loss (as this part of homonculus is affected)
If dominant hemisphere is affected: can cause Wernicke’s and Broca’s aphasia
If non dominant hemisphere affected: neglect

If internal capsule if affected, motor fibres to leg could also be affected

Proximal occlusion of MCA will lead to contralateral homonymous hemianopia (like a lesion at the optic tract)

Question 6

What areas of the brain does the posterior cerebral artery supply?

Answer 6

Occipital lobe

Contains visual cortex

Question 7

What symptoms will a posterior cerebral artery present with?

Answer 7

Occipital lobe affected
Hence visual cortex affected
So px would present with contralateral homonymous hemianopia but with macula sparing (due to MCA supply)

Question 8

What symptoms will a patient with a stroke affecting one of the cerebellar artery present with?

Answer 8

All symptoms are ipsilateral!

DANISH
= dysdiadochokinesia, ataxia, nystagmus, intention tremor, slurred speech, hypotonia

Cerebellar arteries also supply brainstem! So proximal occlusion could cause brainstem symptoms too

Question 9

Brain steam signs could be caused by a stroke affecting one of which arteries?

Answer 9

Cerebellar arteries (proximally, if distal it will cause cerebellar signs only)

Question 10

How would brain steam signs present in a stroke affecting the left hand side of the brain stem.

Answer 10

Crossed deficit
Would affect left hand cranial nerve nuclei so ptosis on left hand side
But would could motor signs on contalateral right hand side of the body as the tracts would dessucate

Question 11

How would stroke affecting the lenticulostriate arteries present?

Answer 11

Pure motor stroke due to affected internal capsule

Question 12

Which part of the brain is affected to cause a pure sensory stroke?

Answer 12

Thalamus

Will be contralateral symptoms

Question 13

What is the preferred method of imagine for a stroke?

Answer 13

CT

Question 14

What are some key differentials for a stroke?

Answer 14

HEMI

= hypoglycaemia, epilepsy, migraines, infection

Question 15

What dosage of aspirin is administered if an ischaemic stroke has been confirmed?

Answer 15

300mg

Question 16

A px has suffered a stroke leading to weakness of the face and upper limb but no other clinical features. Which vessel is occluded?

Answer 16

A lenticulostriate artery in the internal capsule

This has caused a pure motor stroke

Question 17

Blockage of the basilar artery can lead to which syndrome?

Answer 17

Locked in syndrome

Question 18

A px has a homonymous inferiority quadrantanopia. Which lobe has been damaged?

Answer 18

Parietal lobe

(Inferior quadranatanopias occur due to damage to the superior optic radiations which run in the parietal lobe. Temporal lobe lesions can cause superior quadrantanopia as the superior optic radiations will have been damaged)

Question 19

Following occlusion of the anteriiir cerebral artery a px develops RICP and herniates part of their cerebral cortex. Which part of the cerebral cortex is particularly vulnerable?

Answer 19

Cingulate cortex

Can herniate beneath the falx

Question 20

A px presents with a right homonomous hemianopia with macular sparing and sensory deficit affecting all of the right side. Which vessel is likely to have been occluded?

Answer 20

LEFT posterior cerebral artery

Supplies the visual cortex and the thalamus

Question 21

Occlusion of the proximal portion of the superior cerebellar artery may lead to damage to which other structure?

Answer 21

Midbrain

Superior cerebellar artery supplies the midbrain on its way to the cerebellum