Cerebral infection (clinical)

Question 1

What is a stroke?

Answer 1

-Sudden onset of focal or global neurological symptoms which can be caused by ischaemia or hemmorgae lasting more than 24 hours

Question 2

What is a TIA

Answer 2

Sudden onset of focal or global neurological symptoms which can be caused by ischaemia or hemmorgae lasting less than 24 hours

• Most last a couple of minutes
• When it lasts longer it tends to cause some neurological damage

Question 3

Pathology of a stroke/TIA

Answer 3

Disruption of flow through plaque surface
Adhesion of the platelets and fibrin
Formation of thrombus/ embolism
Partial/occlusion

Question 4

Causes of an ischaemic stroke

Answer 4

1.Large artery atherosclerosis (e.g. Carotid)
2.Cardioembolic (e.g. atrial fibrillation)
3.Small artery occlusion (Lacune)
4.Undetermined/Cryptogenic
5.Rare causes
•Arterial dissection
Venous sinus thrombosis

Question 5

Causes of a hemorrhagic stroke

Answer 5

1.Primary intracerebral hemorrhage
2.Secondary hemorrhage
•Subarachnoid hemorrhage
•Arteriovenous malformation

Question 6

What occurs to blood flow when a stroke takes place

Answer 6

Interrupted blood flow, can be transient, can lead to hypoxia
Hypoxia interrupts the metabolism of the brain. If it lasts a long time it leads to ANOXIA= infarction
Further damage to brain can result form oedema and secondary hemorrage.

Question 7

What are the names of the affected stroke area and the area around it?

Answer 7

The area affected by interrupted blood flow is known as the Ischamic core.
The area surrounding this area which might be more or less affected is known as the Ischeamic penumbra.

Question 8

What investigations are made for stroke?

Answer 8

• Most common is MRI
• CT
• Routine bloods ( FBC, glucose, lipids, ESR..)
• ECG (AF?)
• ECHO (valves- stenosis)
• Carotid doppler ultrasound
• Carotid angiogram (vasculitis)
• Hyper-coagulable blood screen

Looking for the cause of the stroke as well as whether or not a stroke has occurred.
Helps with prevention of reoccurrence

Question 9

Which are the non-modifiable risk factors of stroke

Answer 9

• Men (women under the age of 50 are more protected by oestrogen)
• Age
• Previous stroke
• Family history

Question 10

which are the modifiable risk factors for stroke?

Answer 10

• Smoking
• Alcohol
• Hypertension :
• Cholesterol
• Diet(Increased deposit of LDLs in the arterial wall)
• Diabetes
• Cardiac disease
• Use of the Oral contraceptive pill (have high oestrogen/ with high progesterone is fine)
• Hyper coagulable states

Question 11

which is the most significant modifiable risk factor?

Answer 11

Hypertension

High BP is related to stroke- increases risk of atheroma and affects flow through distal arteries

Question 12

Depending on where the stroke takes place which parts of the brain will be affected?

Answer 12

ACA: antero-medial aspect of the cortex 
MCA: 
-lateral aspects of the brain
-Basal ganglia 
PCA:
-Brainstem 
-Occipital lobe 
-lateral temporal lobe
-Cerebellum 
-thalamus

Question 13

symptoms of ACA occlusion

Answer 13

Contra-lateral symptoms

• Paralysis of the foot and leg
• Sensory loss of foor and less
• Impairment of gait and stance

Question 14

General symptoms for MCA occlusion

Answer 14

• Paralysis of arm, face and leg
• Sensory loss of arm, face and leg
• Gaze paralysis- eyes deviate to opposite side so if left side hemianopia- eyes deviate to right
• Aphasia if on dominant side
• Homonyous hemianopia
• Neglect/ agnosia if on non-dominant side (e.g. on the right side, most people are not dominant on the left side of the body)

Question 15

What is a lacunar stroke

Answer 15

Occlusion to small branches which supply the deep internal structures of the brain (basal ganglia)

Question 16

Symptoms of lacunar stroke

Answer 16

• No cortical signs
• Pure motor OR
• Pure sensory
• Dysarthia- clumsy hand syndrome
• Ataxic hemiparesis

Question 17

Symptoms of PCA occlusion

Answer 17

Due to brainstem dysfunction

• Coma
• Vertigo
• Nausea/vom
• Cranial nerve palsy
• Dysphagia
• Visual field deficits
• Hemiparesis
• Hemisensory loss
• Crossed sensory-motor deficits

Question 18

Treatments

Answer 18

• Aspirin
• Heparin
• Neuroprotectant
• Tissue plasminogen activator
• Thrombectomy

Question 19

Indications for IV TPA

Answer 19

Criteria for TPA

• Within 4.5h
• Disabling neurological deficit
• Consent obtained
• symptoms present >60mins

Question 20

Contraindications

Answer 20

Avoid IV TPA when:
-Any signs of a hemorrage:
Blood on CT 
Recent surgery
Recent episodes of bleeding
Coagulation problems 
-High BP : >185 systolic or 110 diastolic
-Glucose <2.8 or >22mmol/L

Question 21

Secondary prevention for strokes

Answer 21

Anti-hypertensives 
Anti-platelets 
Lipid lowering agents 
Warfarin for AF 
Carotid endarterctomy

Question 22

Goals for stroke care

Answer 22

Reduce mortality
Reduce disability associated with stroke
Increase carer/ Patient knowledge
Maximise QoL

Question 23

LOOK AT TABLE FOR CLASSIFICATION OF STROKES

Answer 23

TACS
PACS
POCS
LACS

Question 24

What are the names of the arteries supplying the basal ganglia?

Answer 24

Lenticulostriate arteries

Question 25

What are common symptoms of an MCA stroke due to brainstem dysfunction

Answer 25

• Coma
• Vertigo
• Nausea/vom
• Cranial nerve palsy
• Dysphagia
• Visual field deficits
• Hemiparesis
• Hemisensory loss