Clinical aspects of stroke

Question 1

Stroke =

Answer 1

A sudden focal neurological deficit due to vascular lesion lasting longer than 24 hours.

Question 2

TIA =

Answer 2

Transient ischcemic attack. A focal deficit lasting a few seconds to 24 hours. Complete clinical recovery.

Question 3

What does the homonculous look like for the motor cortex?

Answer 3

Tongue and face us lateral - hand - arm - shoulder - trunk - hip - kneee

Question 4

What does the frontal lobe do?

Answer 4

• Primary motor cortex - contralateral movements
• Broca’s area
• prefrontal areas = personality, initiative, sequencing
• cortical inhibiton of bladder and bowels

Question 5

What areas would an MCA stroke effect?

Answer 5

Hand, face

Question 6

What areas would and ACA stroke effect?

Answer 6

Legs

Question 7

Agnosia =

Answer 7

Inability to use secondary information to interpret the environment

Question 8

Where is Meyer’s loop found?

Answer 8

Parietal lobe

Question 9

Visual defect with occipital lobe stroke:

Answer 9

Contralateral homonymous hemianopia

Question 10

What does homonymous hemianopia mean?

Answer 10

Loss of same visual field in both eyes.

Question 11

2 main types of symptoms coming from the brain

Answer 11

• Negative: loss of function

- Positive: abnormal stimulation

Question 12

Anterior circulation:

Answer 12

Internal carotid
Opthalmic
Posterior communicating
Anterior cerebral
Middle cerebral

Question 13

Posterior circulation

Answer 13

Vertebral arteries 
Posterior inferior cerebellar
Anterior inferior cerebellar 
Basilar 
Anterior spinal
Posterior cerebral

Question 14

Anterior criculation supplies:

Answer 14

Cerebrum

Opthalmic artery

Question 15

Posterior circulation supplies:

Answer 15

Occipital lobe
Cerebllum
Brainstem

Question 16

What supplies the thalamus?

Answer 16

Posterior cerebral artery

Question 17

What do perforating arteries supply?

Answer 17

Brainstem
Basal ganglia
Internal capsule

Question 18

Lacunar stroke is due to:

Answer 18

Occlusion of small penetrating arteries supplying the brains deep structures

Question 19

Why are lacunar strokes not going to get blood supply back?

Answer 19

Don’t have collaterals

Question 20

2 main types of stroke:

Answer 20

1. Ischemic

2. Hemorrhagic

Question 21

Mechanisms of ischemic stroke:

Answer 21

Embolism
Thrombosis
Systemic hypoperfusion
Cerebral venous sinus thrombosis

Question 22

Thrombosis -

Answer 22

Blood clot forms locally in the cerebral vessels.

Question 23

Embolism -

Answer 23

embolus from somewhere else in the body

Question 24

Ex of conditions that can cause embolism

Answer 24

Atrial fibrillation

Deep vein thrombosis (paradoxical)

Question 25

What is a paradoxical embolism?

Answer 25

From vein, clot moves to systemic circulation via an atrial septal defect (e.g. PFO)

Question 26

What can cause systemic hypoperfusion

Answer 26

Cardiac arrest

Question 27

types of haemorrhagic stroke:

Answer 27

Intracerebral haemorrhage | Subarachnoid haemorrhage

Question 28

Causes of haemorrhagic stroke can include:

Answer 28

berry aneurysms high blood pressure arteriole-venous malformation Clotting disorders/meds

Question 29

Large vessels that can be occluded:

Answer 29

Internal carotid | Vertebral

Question 30

Branch vessels that can be occluded:

Answer 30

MCA PCA ACA

Question 31

Mechanism of occlusion:

Answer 31

fatty streak rough cratered plaque which is thrombogenic parts break off, lodge

Question 32

Silent strokes may be the cause of:

Answer 32

Vascular dementia

Question 33

Aetiology of ischemic stroke

Answer 33

- atheroma, plauque - dissection - heart; AF, endocarditis, PFO - small artery disease - fat, air (rare)

Question 34

Blockage of carotid artery will lead to:

Answer 34

``` Contralateral hemipelgia Contralateral hemisensory disturbance Deterioration in consciousness Gaze plasy to sside of lesion global aphasia ```

Question 35

MCA blockage downstream:

Answer 35

Contralaterial: hemiplegia hemianaesthesia, hemianopia Dominant: - Aphasia (expressive/receptive/global) - acalculia - agraphia Non-dominant: - Hemi-neglect - Failure to recognise faces (prosopagnosia)

Question 36

Features of a lacunar stroke:

Answer 36

``` Pure motor Pure sensory Dysarthria Ataxic hemiparesis Sensorimotor ```

Question 37

Dysarthria =

Answer 37

unclear articulation of speech, otherwise linguistically normal

Question 38

Features of posterior circulation stroke:

Answer 38

vertigo ataxia (cerebellar) paresis, sensory loss hemianopia

Question 39

TACI =

Answer 39

total anterior circulation infarct

Question 40

TACI symptoms =

Answer 40

``` hemi motor and sensory deficit hemianopia cortical dysfunction (LOC, confusion) ```

Question 41

PACI =

Answer 41

Partial anterior circulation infarct

Question 42

LACI =

Answer 42

lacunar infarct

Question 43

POCI =

Answer 43

Posterior circulation infarct

Question 44

Symptoms of POCI

Answer 44

vertigo diplopia ataxia

Question 45

Acute treatment of ischemic stroke:

Answer 45

thrombolysis

Question 46

Methods of thrombolysis

Answer 46

tPA (tissue plasminogen activator) | throbectomy

Question 47

Problem with using tPA

Answer 47

Will lyse any clot in the body

Question 48

Acute treatment of haemorrhagic stroke

Answer 48

Lower BP | Reverse anti-coagulation

Question 49

Where is the most effective place to be treated for a stroke

Answer 49

Dedicated stroke unit - specialist staff, rehab, education

Question 50

Ex of MDT involved in stroke:

Answer 50

``` Nurses OT Physio SaLT Dieticians Psychologicsts Pharmacist ```

Question 51

What does every stroke patient need to be assessed for, before which they are nill by mouth

Answer 51

Dysphagia

Question 52

Long term problems after stroke:

Answer 52

``` Mobility Continence Cognition Self-care Communication Pain ```