Patho 2- Stroke Types And Medical Management

Question 1

In cerebral circulation what supplies the brain?

Answer 1

2 vertebral arteries

2 internal carotid arteries

Question 2

What do the internal carotids divide into?

Answer 2

Anterior and middle cerebral arteries

Question 3

How is the basillar artery formed?

Answer 3

2 vertebral arteries pass up through foramina in TP C10 and join anterior to brainstem

Question 4

What happens in the upper brainstem to connect arteries to the circle of willis?

Answer 4

Basillar artery divides
Into 2 posterior cerebral arteries
Connect to circle of willis by 2 small posterior communicating arteries

Question 5

What does middle cerebral artery supply?

Answer 5

Most of outer surface
Sensory motor cortex
Basal ganglia
Internal capsule
Brocas area (L)

Question 6

What does anterior cerebral artery supply?

Answer 6

Frontal lobe

Medial part of sensory motor cortex

Question 7

What does posterior cerebral artery supply?

Answer 7

Occipital lobe
Medial aspect of temporal lobe
Thalamus

Question 8

What does basillar artery supply?

Answer 8

All of brainstem
Cerebellum
Nuclei of cranial nerve

Question 9

Types of stroke

Answer 9

Haemorrhage

Ischemia

Question 10

BAMFORD classification of ischaemic strokes

Answer 10

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

Question 11

General knowledge of ischaemic strokes

Answer 11

80% due to occlusion 
Atheroma of cerebral artery 
Thrombosis- blood clot in brain or neck
Embolism- blood clot moves and blocks blood vessel in brain or neck
MCA>PCA>ACA

Question 12

Embolic stroke

Answer 12

Blood clot moves and blocks blood vessel in brain or neck
Complete stroke- sudden onset
TIA- repeated small emboli, no infarction occurs

Question 13

Thrombotic stroke

Answer 13

Blood clot in brain or neck
Complete stroke- develops overnight
Developing stroke- over a couple of days
TIA- sudden—-> full recovery

Question 14

Medical management of stroke

Answer 14

Treat as medical emergency
MRI/CT scan within 5 hours
Ischaemic 80%- asprin, anticoagulants- thrombolysis
TIA- aprin, prevention work
Other tests- blood tests,angiography, echocardiology
Surgery- thrombectomy, carotid endarterectomy

Question 15

Types of haemorhagic strokes

Answer 15

Intracarotid
Subarachnoid
Subdural
Extradiral

Question 16

Subarachnoid haemorrhage

Answer 16

Bleeding into subarachnoid space
Rupture of congenital aneurysm, arteriovenous malfunction (AVM) or trauma
Sudden intense headache, vomiting, neck stiffness and loss of conciousness

Question 17

Intracerebral haemorrhage

Answer 17

Bleeding into deeper brain parts
Associated with HTN
Arterial walls weaken- micro aneurysms develop- rupture and bleed
Severe headache and vomiting

Question 18

Subdural haemorrhage

Answer 18

Bleeding into subdural space
-trauma
Can be Interval between injury and symptoms
Headache, drowsiness- stupor- hemiparesis- coma

Question 19

Extradural haemorrhage

Answer 19

Bleeding into extradural space
Severe trauma
Tearing of menigeal artery

Question 20

Medical management of haemorrhagic strokes

Answer 20

Treat as medical emergency 
MRI/CT SCAN
SAH- surgery or endolastic procedure
SDH/EDH/ICH- trest HTN
other tests- blood tests, angiography, echocardiology 
Other medications- osmotic agents