CVA (strokes)

Question 1

How is blood supplied to the brain, what are the 2 roots?

Answer 1

2 vertebral arteries up the back of the neck,

2 internal carotid arteries up the front of the neck.

Question 2

When the arteries enter the brain, what circle does it enter and why is that good?

Answer 2

Circle of Willis, it means that if one artistry gets blocked we can hopefully still supply blood to the brain due to bilateral carotid occlusion through the basilar artiery.

Question 3

Where do the two vertebral arteries run up through and what artery do they form?
What then happens to this artery?

Answer 3

Through the foramina in the transverse process of the cervical vertebrae, running up the back of the neck and joining in the front of the brainstem to form the basilar artery.
The Basilar artery divides into 2 posterior cerebral arteries.

Question 4

Where do the internal carotid artery’s run through, and what do they go on to form?

Answer 4

They run up through the front of the neck and divide to form the anterior and middle cerebral arteries.

Question 5

What part of the Brian does the anterior cerebral artery supply?

Answer 5

The frontal lobe, blockages can greatly affect the motor cortex and the medulla, part of the sensorymotor cortex and therefore movement.

Question 6

What part of the brain does the basilar artery supply blood to?

Answer 6

The mid part of the brain, which is where the brainstem sits (pons, medulla, and midbrain stem) and where the control centres for the heart and the lungs. As well as the cerebellum (responsible for balance and coordination).

Question 7

What part of the brain does the middle cerebral artery supply?

Answer 7

Most of the outer surface, the sensory motor cortex,the Basal ganglia, the internal capsule and Broca’s area on the left (responsible for motor production of speech.
.

Question 8

What area of the brain does the posterior cerebral artery supply?

Answer 8

It supply’s the occipital lobe, medial temporal lobe and the thalamus.

Question 9

Define a stroke?

Answer 9

A stroke is a rapidly developing clinical signs of focal and global loss of cerebral function lasting more than 24 hours+ with no apparent cause other than vascular.

Question 10

What is transient Ischaemic attack?

Answer 10

This is a ministroke. It is a sign that part of the brain is not getting enough blood due to a blood clot becoming stuck in a small blood vessel, however this then frees itself preventing a ischemic stroke, however there is risks of more serious strokes in the future with symptoms lasting less than 24 hours.

Question 11

What signs can you normally see during a stroke?

Answer 11

Facial weakness
Arm weakness
Speech problems
Anything that’s not normal for the individual.

Question 12

What are the normal causes of a stroke?

Answer 12

There are two main causes: haemorrhage (flow of blood following a blood clot) 20% or ischaemia (starving of oxygen) 80%.

Ischaemic strokes are most common in the middle cerebral artery.

Question 13

According to the Bamford classification of ischaemic strokes what are the four types.

How do we decide which one it is?

Answer 13

TACS-total anterior circulation stroke
PACS-partial anterior circulation stroke
POCS- posterior circulation stroke
LACS- lacunar stroke ( deep penetrating arteries)

TACS= individuals has all 3 of these symptoms- unilateral weakness(sensory deficit of arms legs and face), homonymous hemianopia, higher cerebral dysfunction (dysphasia and visuospatial disorder)

PACS= individual has two of these symptoms-unilateral weakness(sensory deficit of arms legs and face), homonymous hemianopia, higher cerebral dysfunction (dysphasia and visuospatial disorder)

POCS= individual has 1 of the following symptoms- cerebral or brainstem syndrome, loss of consciousness, isolated homonymous hemianopia.

LACS= individual has 1 of the following symptoms- unilateral weakness, pure sensory stroke, ataxic hemiparesis

Question 14

How is an ischaemic stroke caused?

Answer 14

1. caused by an atheroma of the cerebral artery
2. A blood clot in the brain or neck which usually develops over night( thrombosis)
3. A blood clot from somewhere else that has moved and caused a blockage in the brain or neck (embolism)

Question 15

What are the medical management strategies of embolisms and thrombotic strokes?

Answer 15

MRI and CT scans are given within 5 hours.

Aspirin anticoagulant and thrombolysis are given to thin out the blood.

Blood test‘s Anygiography and echocardiology.

Thrombectomy carotid Endarterectomy surgeries are carried out to remove plaques.

Question 16

What is an embolic stroke?

Answer 16

When a blood clot moves from a part of the body into a smaller blood vessel blocking it and stoping blood flow to the brain.

Question 17

What is ischaemic penumbra?

Answer 17

When the neurons surrounding the part of the brain being starved if oxygen, are slowly being damaged.

Question 18

What is a thrombotic stroke?

Answer 18

Where a blood clot forms on site and results in parts of the brain being starved of oxygen.

Question 19

What are the 4 types of haemorrhaging strokes?

Answer 19

Intracerebral haemorrhage
Subarachnoid haemorrhage
Subdural haemorrhage
Extradural haemorrhage

Question 20

What is an intracerebral haemorrhage and what are the symptoms?

Answer 20

Bleeding into the deeper parts of the brain (frontal and parietal lobe) due to hypertensions(high blood pressure) weakening the arterial walls causing micro-aneurysms which can rupture and bleed into the brain.

Symptoms=headache and vomiting

Question 21

What is a subarachnoid haemorrhage and what are the symptoms?

Answer 21

Bleeding in to the subarachnoid space due to a rupture of congenital aneurysm, arrteriovenous malformations or trauma.

Symptoms include: sudden intense headaches, vomiting, neck stiffness and loss of consciousness

Question 22

What is a subdural haemorrhage?

Answer 22

Bleeding into the subdural space, usually caused by trauma.

Symptoms include: headache, drowsiness, stupor, hemiparesis, comas

Question 23

What is an extradural haemorrhage?

Answer 23

Bleeding into the extramural space, cause by severe trauma tearing of meningeal artery.

Question 24

What are the medical management of haemorrhagic strokes?

Answer 24

They are treated as a medical emergency,
use an MRI or CT scan to show weather it is a clot or haemorrhage.
Use surgery or endoplastic procedures.
Treat hypertension.
Do blood tests and angiography and echocardiology.
Give osmotic agents to keep the blood pressure low.

Question 25

What is hemiplegia?

How is this different from hemiparesis?

Answer 25

Right or left sided paralysis of the body.

This is different to hemiparesis as this is only weakness to one side not paralysis.

Question 26

What are the 4 clinical features of a Stroke?

Answer 26

Motor symptoms, sensory symptoms, speech symptoms, cognitive symptoms.

Question 27

What is the main descending pathway that is affected by a stroke?

Answer 27

The cortico-spinal tract.

Question 28

What are the motor symptoms?

Answer 28

Alterations in tone:

high (Spasticity)
low (flaccidity)tone
ataxia( lack of co-ordination,balance and speech)
*Immediately after a stroke most patients will have low tone due to the brain being in shock.

Weakness, asymmetry, loss of normal movement patterns, loss of postural adjustments (trunk balance)

Unaffected side also acts to counterbalance affected side, which further limits use of affected side.

Question 29

What typical spasticity do you see in the upper and Lower limbs?

Answer 29

Flexor pattern in upper limb:

• shoulder elevation and retraction
• internal rotation and adduction
• elbow flexion and pronation
• wrist flexion
• finger flexion

Extensor pattern in lower limb:

• hip retraction
• hip extension
• knee extension
• ankle plantarflexion and inversion

Question 30

What are sensory symptoms?

Answer 30

Hyper or hypo sensations,
Impaired cutaneous sensation,
Stereognosis,
Proprioceptive impairment,
Visual field loss,
Homonymous hemianopia (only seeing half of what’s actually there)

Question 31

What are speach symptoms?

Answer 31

Dysarthria (slurred speech),

Expressive dysphasia:
Lost ability to produce speech,
Usually caused by damage to the Broca’s area(left side of the brain, therefore caused by right hemiplegia)… ask them closed questions

Receptive dysphasia:
Lost ability to understand speech, usually caused by damage to the wernikes area in the temporal lobe.

Question 32

What are the cognitive symptoms, and what does agnosia mean?

Answer 32

Perceptual problems:
Agnosia=Inability to recognise objects when using a specific sense
Astereognosis (can’t recognise spatial awareness)
Visual agnosia (can’t visualise objects)
Auditory agnosia (can’t recognise sounds)

Apraxia: can’t do things in the right order

Anosagnosia/ neglect: when an individual doesn’t recognise they’ve had a stroke, normally more common in those with left hemiplegia

Question 33

What is the difference between apraxia and ataxia?

Answer 33

Apraxia is a lack of motor planning.

Ataxia is a lack of coordination.

Question 34

What are other symptoms related to post stroke?

Answer 34

Emotional disorders,
Dysphagia (absent/ delayed swallow reflex),
Incontinence,
Balance and gait problems,
Social problems,
Secondary musculoskeletal problems.

Question 35

What are the factors that affect recovery from strokes?

Answer 35

Extent and nature of lesion,
Integrity of the Circulation in the brain,
Pre-morbid status,
Age,
Capacity of nervous system to re-organise,
Environment,
Motivation and attitude of patient,
Patient participation and experience,
Co-existing conditions,
Nutrition and hydration.

Question 36

What are the risk factors for a stroke?

Answer 36

Age,
Obesity,
Smoking
Contraceptive pill ( containing oestrogen),
Exercise,
Stress,
High salt diet,
Diabetes mellitus,
Hypertension ( high BP, systolic> 160mmHg, diastolic>95mmHg),
Ischaemic  heart disease, 
Atrial fibrillation (irregular heart beats causing clots),
High blood cholesterol.

Question 37

What is the process of neuroplasticity?

Answer 37

the ability of the brain to change throughout an individual’s life, through making connections stronger by practicing new activities.
This won’t occur if a task isn’t interesting, motivating.

Question 38

What part of the brain does the basilar artery supply blood to?

Answer 38

The brain stem, cerebellum, and cranial nerves.