ILA 7 - Stroke SBA Flashcards
An 89-year-old man presents with acute onset of weakness and numbness of his left lower leg and foot is unusually agitated and in an aggressive mood.
Which artery is likely to have been affected?
A. Anterior cerebral artery
B. Basilar artery
C. External carotid artery
D. Middle cerebral artery
E. Posterior cerebral artery
A. Anterior cerebral artery
Supplies the anteromedial surface of the cerebral hemisphere.
Paraplegia usually affects the lower limbs sparing the upper limbs and face.
They may be incontinent.
They may display frontal lobe symptoms e.g. personality changes
As part of a neurological examination, you ask the patient to walk a few steps. When they do so they walk with a wide unsteady gait and appear uncoordinated. Their speech is slurred.
Where is the likely lesion?
A. Brainstem
B. Cerebellum
C. Frontal lobe
D. Occipital lobe
E. Parietal lobe
B. Cerebellum
Patients have a wide unsteady gait
Impaired coordination
Uncontrolled repetitive eye movements
Difficulty with fine motor tasks
Intentional Tremor
Slurred speech
You are taking a history from an elderly gentleman who has had a stroke; he keeps trying to take his gown off and some of his responses are inappropriate and occasionally rude.
Where is the likely lesion?
A. Brainstem
B. Cerebellum
C. Frontal lobe
D. Occipital lobe
E. Parietal lobe
C. Frontal lobe
Decreased lack of spontaneous activity - no desire to do anything and is unable to plan activities.
Loss of attention - lack of interest and is easily distracted.
Memory is normal but the patient cannot be bothered to remember.
Loss of abstract thought - eg, cannot understand proverbs.
Perseveration - a tendency to continue with one form of behaviour when a situation requires it to change.
Change of affect - the patient either becomes apathetic and ‘flat’ or becomes over-exuberant and childish or uninhibited with possibly inappropriate sexual behaviour.
A 53-year-old man with hypertension is admitted following a sudden collapse and is unable to move any part of his body except for eye movements, he appears to understand your questions, but is unable to answer.
A. Brainstem
B. Cerebellum
C. Frontal lobe
D. Occipital lobe
E. Parietal lobe
A. Brainstem
This is locked-in syndrome.
Patients cannot move or communicate verbally due to paralysis of nearly all voluntary muscles.
Blinking and vertical gaze may be preserved depending on the extent and level of the lesion within the brainstem
They are conscious and aware.
Complete recovery is rare.
Whilst examining an elderly lady on the stroke ward, it becomes apparent that she can only see one half of your face.
Where is the likely lesion?
A. Brainstem
B. Cerebellum
C. Frontal lobe
D. Occipital lobe
E. Parietal lobe
D. Occipital lobe
Typically cause visual disturbances and depends on where the lesion is
These can include visual illusions and hallucinations
Trouble recognising objects or facial blindness
Being able to write but not read
When a lesion affects most of the occipital lobe on one side it can cause an homonymous hemianopia which means the patient is unable to see the visual field on the opposite side of the lesion
A 51-year-old man has a 2-month history of weakness in both of his hands, he is now unable to open jars. His hands show wasting of the thenar eminence. He has recently developed slurred speech and difficulty swallowing. His tongue appears spastic, and he is unable to protrude it.
Which of these is the likely cause?
A. Motor neurone disease
B. Multiple sclerosis
C. Myasthenia gravis
D. Spinal cord compression
E. Stroke/Transient Ischaemic Attack
A. Motor neurone disease
Progressive disorder of unknown aetiology
Onset usually after age 50. Males more likely to be affected.
Present with combination of both UMN and LMN signs without sensory involvement.
Symptoms include – limb weakness, cramps, disturbance of speech or swallowing.
Signs – wasting and fasciculation of muscles, pyramidal tract involvement causing spasticity and exaggerated tendon reflexes
Symptoms can start focally but become widespread with time
A 30-year-old woman noticed both her eye lids becoming progressively droopier with time (ptosis). Weeks later she began to experience double vision and found it progressively more tiring and difficult to chew while eating. Which of these is the likely cause?
A. Motor neurone disease
B. Multiple sclerosis
C. Myasthenia gravis
D. Spinal cord compression
E. Stroke/Transient Ischaemic Attack
C. Myasthenia Gravis
• Condition of the neuromuscular junction
• Acetylcholine receptors are blocked by an auto immune reaction between the receptor protein and anti-acetylcholine receptor antibody.
• Women more affected than men. Presents between 15 to 50 years.
• Main symptom is abnormal fatigable weakness of muscles.
• First symptoms are usually ptosis or diplopia.
• Weakness of chewing, swallowing, speaking or limb movement can occur.
A 40-year-old woman felt immediate back pain and a popping sensation after lifting a heavy box. The next day she noticed she was tripping over her right foot as it was dragging along the floor.
Where is the cause most likely to be located?
A. Muscle
B. Nerve root
C. Neuromuscular junction
D. Peripheral nerve
E. Upper motor neurone
B. Nerve root
This is a case of foot drop
It is caused by paralysis of the muscles that lift the foot
Given the history the most likely cause of damage is compression of the nerve root by a prolapsed vertebral disc.
A 42 year old woman suffers a violent headache followed by sudden collapse. You notice that her left pupil is fixed and dilated and her left eye is deviated laterally and downwards.
Which artery is likely to have been affected?
A. Anterior communicating artery
B. Basilar artery
C. External carotid artery
D. Middle cerebral artery
E. Posterior communicating artery
E. Posterior communicating artery
This is most likely due to rupture of a posterior communicating aneurysm leading to a sub arachnoid haemorrhage.
This has caused an ipsilateral third nerve palsy causing her pupil to dilate and the eye to deviate laterally and downwards.
Paralysis of the third cranial nerve affects the medial, superior, and inferior recti, and inferior oblique muscles.
The eye is incapable of movement upwards, downwards or inwards, and at rest the eye looks laterally and downwards owing to the overriding influence of the lateral rectus and superior oblique muscles respectively.
The circle of Willis is an essential part of the blood supply to the brain.
Which of these supplies the circle of Willis?
A. Anterior spinal artery
B. Internal carotid artery
C. Labyrinthine artery
D. Middle cerebral artery
E. Pontine artery
B. Internal carotid artery
An elderly patient has a stiff flexed arm, and a stiff extended leg (both on the left) which they find difficult to bend.
Where is the cause most likely to be located?
A. Muscle
B. Nerve root
C. Neuromuscular junction
D. Peripheral nerve
E. Upper motor neurone
E. Upper motor neurone
A 30-year-old pregnant lady complains to the GP of progressive hand weakness. She is unable to open jars and even grip her tea cup. The GP noticed that the muscles around her thumb were wasting.
A. Muscle
B. Nerve root
C. Neuromuscular junction
D. Peripheral nerve
E. Upper motor neurone
D. Peripheral nerve
Carpal tunnel syndrome
• This due to compression of the median nerve in the carpal tunnel.
• Wasting of the abductor pollicis brevis can develop with the following distribution of numbness and pain.
A 69-year-old lady was slurring her words at a coffee morning. At the same time her right arm began to feel heavy and weak. 24 hours later all her symptoms had resolved. Which of these is the likely cause?
A. Motor neurone disease
B. Multiple sclerosis
C. Myasthenia gravis
D. Spinal cord compression
E. Transient Ischaemic Attack
E. Transient Ischaemic Attack
Acute stroke is characterised by sudden onset of focal neurological deficit e.g. hemiplegia
Can be ischaemic or haemorrhagic
If function recovers within 24 hours then it is termed a transient ischaemic attack (TIA)
