Anatomy and Physiology of Stroke Flashcards

1
Q

What is a transiet ischaemic attack?

A

A stroke that resolves within 24 hours from the onset of symptoms

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2
Q

What are the two main types of stroke?

(name one additional cause)

A

Ischaemic (85%)

Haemorrhagic (10%)

venous sinus thrombosis / dissection

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3
Q

What are two common causes of emboli that can cause stroke?

A

Carotid Artery Atherosclerosis

Atrial Fibrillation

  • Valvular Disease*
  • Septic Emboli (endocarditis)*
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4
Q

Which two cerebral arteries comprise the anterior circulation of the brain?

A

Anterior Cerebral Artery

Middle Cerebral Artery

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5
Q

Which major artery of the head and neck supplies the anterior circulation of the brain?

A

Internal Carotid

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6
Q

Which arteries comprise the posterior circulation of the brain?

A

Posterior Cerebral Arteries

Cerebellar Arteries

Arteries Supplying Brainstem

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7
Q

Which area of the brain would be affected by an anterior artery occlusion?

A

medial aspect of frontal and parietal lobe

anterior part of corpus callosum

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8
Q

Which homuncular area corresponds to the medial aspect of frontal and parietal lobe?

A

motor and sensory innervation to

lower limb and genitals

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9
Q

How may a patient present with following stroke due to an anterior cerebral artery occlusion?

A

Motor

contralateral weakness of lower limb

Sensory

contralateral loss of all sensory modalities

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10
Q

What is the role of the paracentral lobule, where are they located and a stroke involving which vessel may lead to altered function?

A

controls micturation and defecation

located on medial aspect of hemisphere as a continuation of pre- and post-central gyri

anterior cerebral artery occlusion can lead to incontinence

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11
Q

Which area of the brain is supplied by the middle cerebral artery?

A

majority of the lateral hemisphere
(frontal, parietal and temporal lobe)

basal ganglia, internal capsule and macular cortex

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12
Q

Which homuncular area corresponds to the majority of the lateral aspect of the frontal and parietal lobes?

A

motor and sensory cortex

supplying the face, arms and trunk

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13
Q

Outline the conditon ‘malignant MCA’

A

occlusion of the middle cerebral artery

death of large amount of brain tissue

significant cerebral oedema > causing raised ICP

resulting in coma ± death

(decompressive hemicraniectomy illustrated)

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14
Q

Why do some patients with a stroke cause by MCA occulsion present with face, arm, trunk and leg weakness, whereas some may only present with face, arm and trunk weakness?

A

proximal occlusion of the MCA interrupts blood supply to the lenticulostriate arteries supplying the internal capsule

distal occlusion of the MCA spares the lenticulostriate arteries, results in motor weakness of the areas innervated from the lateral homunculus

(internal capsule contains ALL descening pathways from motor cortex)

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15
Q

As the middle cerebral artery has many branches, what visual defects may occur if the parietal and/or the temporal lobes are affected?

A

proximal occlusion of MCA

contralateral homonymous hemianopia

distal occlusion of MCA

contratateral homonymous superior or inferior quadrantinopiua (rare)

superior - parietal lobe affected / inferior - temporal lobe affected

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16
Q

Which hemisphere of the brain is most likely to be affected if a patinet presents with speech difficulties following a stroke?

How would a patinet present with a stroke affecting:

Broca’s Area

Wernicke’s Area

Both Broca’s and Wernicke’s Area

A

Left Hemisphere

  • Broca’s Area
    • expressive aphasia - struggle to find words
  • Wernicke’s Area
    • receptive aphasia - speaks fluently but nonsece
  • Both Broca’s and Wernicke’s Area
    • aphasic - does not understand or communicate
17
Q

Which hemisphere is commonly affected to cause a hemispacial neglet or tactile extinction?

A

Non-Dominant

Hemispatial Neglect - neglect half of their body/life

Tactile Extinction - only report sensation on one side of body when touched together (can feel individually)

(likely right)

18
Q

Which area of the brain is supplied by the posterior cerebral artery?

A

inferior temporal lobe

occipital lobe

cerebellum

brainstem

19
Q

When a patinet suffers an occlusion of the posterior cerebral artery, which artery provides the collateral circulation to afford macular sparing with a homonymous hemianonia?

A

middle cerebral artery

20
Q

What symptoms may a patient present with following a cerebellar stroke, caused by occlusion of the cerebellar artery?

think ‘DANISH’

A
  • D - dysdiadochokinesia
  • A - ataxis
  • N - nystagmus
  • I - intention tremor
  • S - slurred speech
  • H - hypotonia
21
Q

What is a ‘cross deficit’ in the context of a brainstem stroke?

A

damage to long tracts (ascending and descending pathways) on contralateral side of body

damage to cranial nerves or their nuclei gives ipsilateral side
(e.g. CN III palsy)

22
Q

Occlusion of which cerebral artery can be associated with ‘locked in’ syndrome if the lesion is very proximal, and why?

A

Basilar Artery

Why?

the pons contains corticospinal tracts (motor pathways), therefore occlusion will lead to quadraplegia, as well as loss of all cranial nerves except CN I, II, III, IV

23
Q

Why are patients at risk of total blindness if the basilar artery becomes occluded?

A

basilar artery is a single blood supply before splitting into left and right posterior cerebral arteries

therefore distal occlusion will result in ischaemia of both the left and right visual cortex causing total blindness

24
Q

Which area of the brain is supplied by the lenticulostriate arteries and from which major artery do they arise?

A

Supply Internal Capsule

Branch of Middle Cerebral Artery

25
Q

The internal capsule can be divided into an anterior limb, posterior limb and genu; what function is provided by the posterior limb and genu?

A

Posterior Limb

carries descending motor fibres for entire body

Genu

contains the motor fibres for the face

26
Q

Lesions of which structure will produce pure motor hemiparesis?

A

Internal Capsule

27
Q

What will be the effect of a stroke affecting the left thalamoperforator artery (a branch of the posterior cerebral artery)?

A

pure sensory stroke
(as lesion affects thalamus)

asending inputs are not able to reach the post-central gyrus, therefore the patient will present with right sided sensory loss of ALL modalities

28
Q

Although MRI is better at highlighting strokes in the hyperacture phase, why are CT scans often performed more frequently in the early stages?

A

identify haemorragic stroke
(patients not eligable for thrombolysis)

CT is quicker and cheaper to allow thrombolysis treatment to be started as soon as possible