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Neurological, neuromuscular and musculoskeletal disease > Clinical aspects of stroke > Flashcards

Clinical aspects of stroke Flashcards

1
Q

Stroke =

A

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

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2
Q

TIA =

A

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

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3
Q

What does the homonculous look like for the motor cortex?

A

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

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4
Q

What does the frontal lobe do?

A
  • Primary motor cortex - contralateral movements
  • Broca’s area
  • prefrontal areas = personality, initiative, sequencing
  • cortical inhibiton of bladder and bowels
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5
Q

What areas would an MCA stroke effect?

A

Hand, face

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6
Q

What areas would and ACA stroke effect?

A

Legs

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7
Q

Agnosia =

A

Inability to use secondary information to interpret the environment

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8
Q

Where is Meyer’s loop found?

A

Parietal lobe

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9
Q

Visual defect with occipital lobe stroke:

A

Contralateral homonymous hemianopia

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10
Q

What does homonymous hemianopia mean?

A

Loss of same visual field in both eyes.

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11
Q

2 main types of symptoms coming from the brain

A
  • Negative: loss of function

- Positive: abnormal stimulation

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12
Q

Anterior circulation:

A 
Internal carotid
Opthalmic
Posterior communicating
Anterior cerebral
Middle cerebral
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13
Q

Posterior circulation

A 
Vertebral arteries 
Posterior inferior cerebellar
Anterior inferior cerebellar 
Basilar 
Anterior spinal
Posterior cerebral
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14
Q

Anterior criculation supplies:

A

Cerebrum

Opthalmic artery

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15
Q

Posterior circulation supplies:

A

Occipital lobe
Cerebllum
Brainstem

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16
Q

What supplies the thalamus?

A

Posterior cerebral artery

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17
Q

What do perforating arteries supply?

A

Brainstem
Basal ganglia
Internal capsule

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18
Q

Lacunar stroke is due to:

A

Occlusion of small penetrating arteries supplying the brains deep structures

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19
Q

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

A

Don’t have collaterals

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20
Q

2 main types of stroke:

A
  1. Ischemic

2. Hemorrhagic

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21
Q

Mechanisms of ischemic stroke:

A

Embolism
Thrombosis
Systemic hypoperfusion
Cerebral venous sinus thrombosis

22
Q

Thrombosis -

A

Blood clot forms locally in the cerebral vessels.

23
Q

Embolism -

A

embolus from somewhere else in the body

24
Q

Ex of conditions that can cause embolism

A

Atrial fibrillation

Deep vein thrombosis (paradoxical)

25
Q

What is a paradoxical embolism?

A

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

26
Q

What can cause systemic hypoperfusion

A

Cardiac arrest

27
Q

types of haemorrhagic stroke:

A

Intracerebral haemorrhage

Subarachnoid haemorrhage

28
Q

Causes of haemorrhagic stroke can include:

A

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

29
Q

Large vessels that can be occluded:

A

Internal carotid

Vertebral

30
Q

Branch vessels that can be occluded:

A

MCA
PCA
ACA

31
Q

Mechanism of occlusion:

A

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

32
Q

Silent strokes may be the cause of:

A

Vascular dementia

33
Q

Aetiology of ischemic stroke

A
  • atheroma, plauque
  • dissection
  • heart; AF, endocarditis, PFO
  • small artery disease
  • fat, air (rare)
34
Q

Blockage of carotid artery will lead to:

A 
Contralateral hemipelgia
Contralateral hemisensory disturbance
Deterioration in consciousness
Gaze plasy to sside of lesion
global aphasia
35
Q

MCA blockage downstream:

A

Contralaterial: hemiplegia hemianaesthesia, hemianopia

Dominant:

  • Aphasia (expressive/receptive/global)
  • acalculia
  • agraphia

Non-dominant:

  • Hemi-neglect
  • Failure to recognise faces (prosopagnosia)
36
Q

Features of a lacunar stroke:

A 
Pure motor
Pure sensory 
Dysarthria
Ataxic hemiparesis
Sensorimotor
37
Q

Dysarthria =

A

unclear articulation of speech, otherwise linguistically normal

38
Q

Features of posterior circulation stroke:

A

vertigo
ataxia (cerebellar)
paresis, sensory loss
hemianopia

39
Q

TACI =

A

total anterior circulation infarct

40
Q

TACI symptoms =

A 
hemi motor and sensory deficit
hemianopia
cortical dysfunction (LOC, confusion)
41
Q

PACI =

A

Partial anterior circulation infarct

42
Q

LACI =

A

lacunar infarct

43
Q

POCI =

A

Posterior circulation infarct

44
Q

Symptoms of POCI

A

vertigo
diplopia
ataxia

45
Q

Acute treatment of ischemic stroke:

A

thrombolysis

46
Q

Methods of thrombolysis

A

tPA (tissue plasminogen activator)

throbectomy

47
Q

Problem with using tPA

A

Will lyse any clot in the body

48
Q

Acute treatment of haemorrhagic stroke

A

Lower BP

Reverse anti-coagulation

49
Q

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

A

Dedicated stroke unit - specialist staff, rehab, education

50
Q

Ex of MDT involved in stroke:

A 
Nurses
OT
Physio
SaLT
Dieticians
Psychologicsts
Pharmacist
51
Q

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

A

Dysphagia

52
Q

Long term problems after stroke:

A 
Mobility
Continence
Cognition
Self-care
Communication
Pain

Neurological, neuromuscular and musculoskeletal disease (22 decks)

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