Clinical Stroke- Syndromes And Management

Question 1

What is a stroke

Answer 1

Sudden onset, focal dysfunction

Question 2

What are the classification of stroke

Answer 2

Cerebral infarct
Intracerebral haemmorhage
Subarachnoid haemorrhage

Question 3

How does a cerebral infarct happen

Answer 3

1. When you get an infarct you block off a blood vessel
2. Blood flow drops
3. Blood flow less than 10ml/min/100g causes cytotoxic cell death and apoptosis which is irreversible
4. Area in the brain dies off (called the core)
5. Blood can flow in the area of the blocked vessel by collateral flow which can provide some perfusion
6. If blood flow drops to 20-10ml/min/100g you get a penumbra which is when cells are not dead straight away but there is an electrical failure in potential reversible state
7. If its in penumbra for a long time it can die off

Question 4

What are the mechanism for an cerebral infarct

Answer 4

1. Large artery disease
2. Cardioembolic stroke
3. Small artery disease
4. Cyrptogenic stroke
5. Other causes of stroke: carotid dissection, vasculits, endocarditis

Question 5

What is large artery disease

Answer 5

This is when there is buildup of cholesterol plaque in large arteries, the plaque can rupture to occlude the vessel

Question 6

What is a carotid dissection

Answer 6

You get trauma to the blood vessel and a haematoma within the wall, the haematoma can occlude the vessel or rupture into the vessela nd embolise distally

Question 7

What are the carotid dissection symptoms

Answer 7

Horners syndrome: ptosis, meiosis, anhydrosis
Unilateral pain in face, head and neck
Anterioir ciruclation stroke syndrome

Question 8

Why does horners syndrome occur in carotid dissection

Answer 8

Due to sympathetic supply of the eye travelling up the carotif which can become damaged when you have a haematoma

Question 9

What is a cardioembolic stroke

Answer 9

When the blood clots form in the heart and then embolise to the brain. Can be caused by atrial fibirllation (poorly coordinated contraction causes formation of clots in the heart and can embolise to the brain)

Question 10

What is small artery disease/lacunar stroke

Answer 10

When you get atherosclerosis in small arteries that involve the deep white matter and the brain stem.
Atherosclerosis occurs due to hypertension, diabetes, hyperlipidemia

Question 11

What are the types of intracerebral haemorrhage

Answer 11

Primary

Secondary

Question 12

What is primary intracerebral haemorrhage

Answer 12

Due to hypertension and amyloid angiopathy

Question 13

What is secondary intra cerebral haemorrhage

Answer 13

Deu to a physical problem e,g tumour, impaired coagulation due to warfarin

Question 14

What is a subarachnoid haemorrhage

Answer 14

Bleeding in the subarachnoid space that will come from berry aneurysm

Question 15

What is a extradural haemmorhage

Answer 15

Usually a bleed from the middle meningeal artery when you get hit on the side of the head

Question 16

What is the arterial supply of the brain by

Answer 16

2 internal carotid artery that come off from the common carotid artery
2 vertebral arteries

Question 17

What does the 2 internal carotid artery and 2 vertebral artery connect to form

Answer 17

The circle of willis

Question 18

What does the 2 vertebral arteries join together to form

Answer 18

The basilar artery

Question 19

What does the internal carotif artery become

Answer 19

Middle cerebral artery

Anterioir cerebral artery

Question 20

What area does the internal carotid artery supply

Answer 20

Anterioir brain

Question 21

What area does the vertebrobasillar artery supply

Answer 21

Brainstem and cerebellum

Question 22

What can stroke syndromes be seperated into

Answer 22

Anterioir circulation stroke- from carotid artery supply
Posterior circualtion stroke- from vertebrobascilar circulation
Lacunar stroke- small vessel disease that can be in anterior or posterir circulation

Question 23

What are the causes of anterior circulartion stroke

Answer 23

Thrombotic occulisin- cardioembolic

Intracerebral haemmorhage secondary to vascular malformation and tumour

Question 24

What are the signs in anterior circulation stroke

Answer 24

1. Contralateral UMN hemiparesis or hemisensory loss e.g upgoing plantars in one feet and other feet normal
2. High mental function problem e.g stuttering speech (expressive) or receptive i.e speaking garbage- this is if in dominant left cortex or if non dominant right cortex (difficulty performing a difficult task when motor is ok) e.g not knowing how to dress
3. Hemianopia- due to visual pathway affected

Question 25

What are the types of anterior circulation stroke

Answer 25

Partial- if 2/3

Total 3/3 or feature 2 on its own

Question 26

What is lacunar syndrome

Answer 26

This can be anterior or posterior:
It can be:
Infarcts in pons and basal ganglia
Deep subcortical haemorrhage

Question 27

What are the features of lacunar syndrome

Answer 27

Contralateral UMN hemiplegia
Contralateral hemisensory loss
Contralateral upgoing plantar
No cortical problem e.g higher cortical problem

Question 28

What is posterior circulation syndrome due to

Answer 28

Vertebrobasillar occlusion- large vessel disease and cardiembolic
Or
Brainstem haemorrhage

Question 29

What are the features of posterior circulation syndrome

Answer 29

Dizziness
Vertigo
Diplopia
Dysphagia
Ataxia
Cranial nerve palsies
Uni/bilateral weakness

Question 30

What is a transient ischaemic attack

Answer 30

The person has a stroke that lasts less than 24 hours

Question 31

What are the causes of TIA

Answer 31

Ishcaemia due to large vessel disease, small vessel disease or cardioembolic