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Clinical neuroscience > L14 - Stroke > Flashcards

L14 - Stroke Flashcards

1
Q

Stroke

A

Neurological deficit due to an acute focal injury of the CNS by a vascular cause

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2
Q

TIA

A

Transient episode of neurological dysfunction without acute infarction due to lack of oxygen.

LASTS LESS THAN 24 HOURS

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3
Q

Types of vascular causes of stroke

A

Ischaemic - 85%
- thromboembolism

Haemorrhagic - 10%

  • intracerebral
  • subarachnoid

Other - 5%

  • dissection
  • Venous sinus thrombosis
  • Hypoxia brain injury
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4
Q

Which type of stroke occurs in young people more?

A

Haemorrhagic : vasculitis

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5
Q

Which type of stroke occurs in old people more?

A

Ischaemic stroke due to thromboembolism

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6
Q

Risk factors for stroke

A 
Hypertension
Diabetes 
Smoking 
CHD
Post TIA 
Polycythaemia Vera 
Hyperlipidaemia
COCP 
Excess alcohol 
Clotting disorders
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7
Q

CHADS2

A

Estimate stroke risk in AF patients

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8
Q

ROSIER

A

Recognition of stroke in the emergency room scale

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9
Q

Anterior cerebral artery stroke

A

Supplies:

  • medial frontal and parietal lobe
  • paracentral lobule
  • corpus callosum

Motor loss:

  • contralateral lower limb
  • incontinence - loss of excitatory and inhibitory projections in the cerebral cortex to the M centre
  • alien hands syndrome

Sensory loss
- contralateral lower limb

Other features:

  • personality change
  • innapropriate behaviour
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10
Q

Proximal middle cerebral artery

A

Supplies:

  • lateral parietal lobe and frontal lobe
  • superior temporal lobe
  • internal capsule (lenticulostriate arteries)

Motor deficit:
- contralateral flaccid hemiparalysis of arm, leg and face (internal capsule affected)

Sensory deficit:
- contralateral upper limb affected

Visual deficit:
- contralateral homonymous hemianopia

Dysphasia: (left sided)

  • Broca’s
  • Wernicke’s

Other:
- left sided hemispacial neglect - when the right parietal lobe is affected

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11
Q

Lenticulostriate artery occlusion

A

Lacuna stroke
15mm infarct
May only have contralateral motor, sensory or mixed deficits depending on where in the internal capsule is affected

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12
Q

Distal middle cerebral artery occlusion of superior division

A

Supplies:

  • lateral frontal lobe
  • primary motor cortex
  • Broca’s area

Deficit:

  • contralateral motor impairment of the upper limb and face
  • Broca’s dysphasia
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13
Q

Distal middle cerebral artery occlusion of inferior division

A

Supplies:

  • lateral parietal lobe
  • superior temporal lobe
  • primary sensory cortex
  • Wernicke’s area
  • both optic radiations
  • macula

Deficits:

  • contralateral sensory loss of the upper limb and face
  • Wernicke’s dysphasia
  • contralateral homonomous hemianopia with no macula sparing
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14
Q

Posterior cerebral artery stroke

A

Supplies:

  • occipital lobe
  • primary visual cortex
  • thalamus
  • midbrain

Deficit:

  • contralateral homonomous hemianopia with macula sparring
  • contralateral sensory loss due to thalamus involvement
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15
Q

Cerebellum lesion symptoms

A

Ipsilateral:

  • dysdiadochokinesis
  • ataxia
  • nystagmus
  • intention tremor
  • slurred speech
  • hypotonia

+ ipsilateral horner’s syndrome due to disruption of the sympathetic that run laterally around the brainstem

+ contralateral sensory signs as pre-decussation

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16
Q

Basilar artery occlusion PCA

A
  • can occlude blood supply to the PCA
  • can cause sudden death

PCA: (at superior aspect of brainstem)

  • visual and occulomotor deficits - occulomotor nulcei
  • cortical blindness with macula sparring
  • hallucinations
  • sleep regulation (as PCA supplies the brainstem RAS)
  • motor movement sparred as cerebral peduncles receives blood from the posterior communicating artery
17
Q

Basillar artery occlusion - pontine arteries

A

Pontine arteries on both side are affected

  • locked in syndrome - complete loss of motor movement except for ocular movement
18
Q

Why is ocular movement sparred in a basillar artery occlusion affected the pontine arteries?

A

Occulomotor nuclei in the midbrain which is supplied by the PCA

19
Q

TACS

A

Total anterior circulation stroke
Large cortical stroke in the middle or anterior cerebral arteries

  • unilateral weakness and/ or sensory deficit
  • contralateral homonomous hemianopia
  • higher cerebral dysfunction - dysphasia or neglect
20
Q

PACS

A

Partial anterior circulation stroke
Cortical stroke in the middle or anterior cerebral artery areas

2 of:

  • unilateral weakness and/ or sensory deficit
  • contralateral homonomous hemianopia
  • higher cerebral dysfunction - dysphasia or neglect
21
Q

POCS

A

Posterior circulation syndrome

  • cerebrallar or brainstem syndromes
  • loss of consciousness
  • isolated homonomous hemianopia
22
Q

LACS

A

Lacunar syndrome

  • subcortical stroke due to smaller vessels
  • no higher cerebral dysfunction
  • unilateral weakened
  • ataxia hemiparesis
  • sensory stroke
23
Q

Rule of 4

A

4 cranial nerves above, in and below the pons

24
Q

Motor nuclei rule

A

The motor nuclei in the pons and medulla that can be divided into 12 are central and the others are lateral

25
Q

4 midline Ms

A

Motor pathways - corticospinal tract
Medial lemniscus - dorsal column
Medial longitudinal fasciculus
Motor nuclei - 3,4,6,12

26
Q

4 side Ms

A

Spinocerebellar pathways
Spinothalamic pathways
Sensory nuclei (trigeminal)
Sympathetic

27
Q

Brainstem pathology

A

Ipsilateral cranial nerve signs

Contralateral sensory and motor tract deficits

Clinical neuroscience (20 decks)

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