Blood Supply and Stroke

Question 1

Describe the course of the vertebral artery

Answer 1

• comes off first part of subclavian artery
• ascends in neck in transverse foramina of transverse processes of C6-C1
• enters foramen magnum, pierces meninges to enter subarachnoid space
• joins together to form basilar artery
• ascends anterior pons
• teminates as posterior cerebral artery

Question 2

Describe the course of the internal carotid artery

Answer 2

• bifurcation of common carotid artery at C3/4
• ascends and passes into skull through carotid canal and passes cavernous sinus
• perforates dura matter at anterior clinoid process
• divides into anterior and middle cerebral artery
• gives off posterior communicating artery

Question 3

What are the 7 segments of the internal carotid artery?

Answer 3

• C1: cervical segment
• C2: petrous segment
• C3: lacerum segment
• C4: cavernous segment
• C5: clinoid segment
• C6: ophthalmic segment
• C7: communicating segment

Question 4

Define TIA

Answer 4

transient neurological dysfunction caused by focal brain/spinal cord/retinal ischaemia without evidence of an acute infarction

Question 5

List and distnguish different stroke syndromes

Answer 5

TACS:
triad of - 
- hemiparesis/hemisensory loss
- dysphasia/visuospatial disorder
- homonymous hemianopia

PACS: 2 of TACS

POCS:
1 of -
- cranial n. palsy and contralateral motor/sensory deficit
- bilateral motor/sensory deficit
- conjugate eye movement disorder (towards affected side)
- cerebellar dysfunction
- isolated homonymous hemianopia

LACS:
1 of - 
- pure motor
- pure sensory
- sensorimotor
- ataxic hemiparesis

Question 6

Describe the effect of an ischaemic stroke of ACA

Answer 6

• contralateral leg weakness and/or sensory loss

- leg > arm weakness

Question 7

Describe the effect of an ischaemic stroke of MCA

Answer 7

• contralateral hemiplegia (upper > lower)
• contralateral hemisensory loss
• conjugate eye deviation (towards affected side)
• contralateral hemianopia

if dominant hemi = global aphasia
if non-dominant = inattention/neglect of contralateral side to stimuli

Question 8

Describe the effect of an ischaemic stroke in PCA

Answer 8

• hemianopia
• if dominant = alexia without agraphia, visual agnosia
• if non-dom = prosopagnosia (unable to recognise faces)
• bilateral: cortical blindness and confabulation (Anton’s Syndrome)

Question 9

Describe the effect of a basilar artery occlusion

Answer 9

• coma/hypersomnolence
• quadriplegia
• diplopia
• locked in syndrome

Question 10

What are the stroke mimics?

Answer 10

• seizures
• sepsis
• syncope
• SOL
• somatisation

Question 11

Describe the treatment and management of an ischaemic stroke

Answer 11

• non-enhanced CT immediately to rule out intra-cranial haemorrhage
• O2 therapy and blood sugar control (4-11mmol/l)
• coagulation screen, FBC, U and Es

Once clinically confirmed:

• thrombolysis with altepase (within 4hr)
• aspirin and antiplatelet therapy (24hrs)
• thrombectomy

Question 12

Describe the secondary prevention after a stroke

Answer 12

• anti-thombotics: clopidogrel/ aspirin + dipyridamole or if AF give warfarin/NOAC
• BP control (<130/80) with CCBs/thiazide diuretics/ACEis
• cholesterol control (<4mmol/l) with statins