Clinical Aspects of Stroke

Question 1

Define a stroke

Answer 1

a sudden, focal neurological deficit due to a vascular lesion lasting longer than 24hrs.

Question 2

Define a TIA

Answer 2

focal deficit lasting a few seconds to 24hrs. there is complete clinical recovery

Question 3

What is the function of Broca’s area and What does damage to Broca’s area cause?

Answer 3

It’s the expressive centre for speech. Loss of the ability to produce language (spoken, manual, or written), although comprehension generally remains intact.

Question 4

What is Wernicke’s aphasia also known as and what is it?

Answer 4

Also called ‘fluent aphasia’ or ‘receptive aphasia’.
The abililty to grasp the meaning of spoken words or sentences is impaired, but the ease of producing connected speech is not very affected.
They often speak normally but what they say doesn’t make sense. they may not realise they are using the wrong words

Question 5

What parts of the brain does the anterior cerebral artery supply?

Answer 5

frontal lobes - including medial surface

Question 6

what parts of the brain does the middle cerebral artery supply?

Answer 6

a portion of the frontal lobe, lateral surface of the temporal and parietal lobes - including the primary motor and sensory areas of the face, throat, hand and arm. and, in the dominant hemisphere, the areas for speech

Question 7

Posterior cerebral artery supplies what parts of the brain?

Answer 7

temporal and occipital lobes

Question 8

where do lenticulostriate arteries branch from?

Answer 8

Middle cerebral artery

Question 9

What is the name of a stroke caused by occlusion of small, deep perforating arteries?

Answer 9

lacunar strokes

Question 10

What percentage of strokes are ischaemic and what percentage are haemorrhagic?

Answer 10

80% ischaemic

~20% haemorrhagic

Question 11

What is the main cause for ischaemic strokes?

Answer 11

large artery atheromatous plaque

Question 12

After atheromatous plaques, what is the next largest cause of ischaemic stroke?

Answer 12

Heart problems - e.g. AF, valve abnormality, endocarditis, PFO, myxoma

Question 13

What causes haemorrhagic strokes?

Answer 13

• hypertension
• artero-venous malformation
• aneurysms
• cerebral amyloid angiopathy
• coagulation disorders or medication related

Question 14

What is homonymous hemianopia?

Answer 14

Loss of half the field of vision in both eyes

Question 15

In a gaze palsy will the eyes deviate towards or away from the side of the lesion?

Answer 15

Towards

Question 16

What is agnosia?

Answer 16

inability to interpret sensations and hence, recognise things. e.g. put a 50p coin in their hand and they can’t work out what it is

Question 17

What is apraxia?

Answer 17

Difficultty with motor planning to perform tasks or movements when asked. inability to put complicated movements together e.g. can’t button up a shirt

Question 18

What symptoms would you see in a stroke in a perforating vessel?

Answer 18

• pure motor stroke
• pure sensory stroke
• dysarthria
• ataxic hemiparesis
• sensorimotor stroke

Question 19

What is the first thing in acute treatment of a stroke?

Answer 19

CT to check it’s ischaemic and not haemorrhagic.

Thrombolysis

Question 20

What is the most commonly used thrombolysis agent?

Answer 20

tPA (alteplase)

Question 21

After thrombolysis, what medication is patient given?

Answer 21

Aspirin and statin

Question 22

What is acute managemetn for haemorrhagic strokes?

Answer 22

lower BP to <160/90 at least.
revese anticoagulation (if taking)

Question 23

What are some common long term problems post-stroke?

Answer 23

• mobility problems
• incontinence
• cognition
• self-care
• communication deficits
• pain