Lecture 16- Stroke 2/2

Question 1

cerevrellar artery occlusions

Answer 1

• think superior cerebellar and anteiror inferior cerebellar artery

Question 2

signs of cerebellar artery occlusion

Answer 2

• DANISh symptoms- ipsilateral
• ipsilateral Horners syndrome
• Contralateral sensory signs

Question 3

DANISH symptoms- Ipsilateral

Answer 3

Cerebellar tracts supply ipsilateral side of the body

Question 4

Ipsilateral Horner’s syndrome in cerebellar occlusion

*

Answer 4

• Superior and inferior cerebellar arteries wrap around the brainstem
  
  • Can also affect sympathetics running laterally

Question 5

Contralateral sensory signs in cerebellar artery occlusion

Answer 5

Sensory pathways run laterally in the brainstem- Pre-decussation

Question 6

Basilar artery occlusions

Answer 6

• Supply the brainstem- can lead to sudden death
• Issues with superior aspect of brainstem e.g. the midbrain
  
  • Visual and oculomotor defects
• Occlusion which spans both side of basilar artery (inc pontine arteries)
• Circle of Willis is a circular therefore can supply most of the cerebral area and the vertebral arteries can supply the some of the brainstem and cerebellar
• Therefore will be a small lesion but can have a large clinical effect e.g. Locked in syndrome
  
  • Complete bilateral motor response
  • Can only do oculomotor movements because ewe are below the oculomotor nuclei
  • Preserved consciousness

Question 7

why can oculomotor movements occur in locked in syndrome

Answer 7

​

• Can only do oculomotor movements because ewe are below the oculomotor nuclei
• Preserved consciousness

Question 8

bamford/oxford classification

Answer 8

predicts extent of stroke, region affected, underlying etiology and prognosis

• TACS
• PACS
• POCS
• LACS

Question 9

TACS (total anterior circulation stroke)

Answer 9

• All 3 of
  
  • Unilateral weakness (+/- sensory deficit) of the face, arm and leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction
    
    • Dysphasia/aphasia
    • Visuospatial disorder

Question 10

PACS (partial anterior circulation stroke)

Answer 10

• Only 2 of
  
  • Unilateral weakness (+/- sensory deficit) of the face, arm and leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction
    
    • Dysphasia/aphasia
    • Visuospatial disorder

Question 11

POCS (posterior circulation stroke)

Answer 11

• One of the following
  
  • Cranial nerve palsy and contralateral motor/sensory deficit
  • Bilateral motor/sensory deficit
  • Conjugate eye movement disorder
  • Cerebellar dysfunction
  • Isolated homonymous hemianopia (with macular sparing)

Question 12

LACS (lacunar strokes 15ml lesions)

Answer 12

• One of the following:
  
  • Pure sensory deficit
  • Pure motor deficit
  • Senori-motor deficit
  • Ataxic hemiparesis

Question 13

stroke syndromes summary

Question 14

rules of 4s for brainstem stroke: rule 1

Answer 14

• Can divide cranial nerve nuclei to 4 above the pons
  
  • Cerebrum
    
    • Olfactory tract
    • Thalamus
  • Midbrain
• 4 within the pons
• 4 within the medulla

Question 15

rule of 4s for brainstem stroke: rule 2

Answer 15

• 4 CN nuclei originate on the midline
  
  • These nuclei are subdivision of the number 12
  • Anything from the pons below, if they times together to make 12 then motor nuclei will be found on the midline
  • No motor nuclei in CN 1 and 2
• CN 5, 7, (no 8 because no motor nuclei), 9, 10, 11 motor nuclei found more laterally

Question 16

rule of 4s for brainstem stroke: Rule 3

Answer 16

Question 17

rule of 4s for brainstem stroke: Rule 4

Answer 17

Question 18

the key rule

Answer 18