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[AMS] Clinical Neuroscience > S10) Anatomy and Physiology of Stroke > Flashcards

S10) Anatomy and Physiology of Stroke Flashcards

1
Q

What is a stroke?

A

A stroke is the damaging/killing of brain cells starved of O2 as a result of blood supply to part of the brain being cut off

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2
Q

What is a TIA?

A

A transient ischaemic attack is a stroke that recovers within 24 hours from the onset of symptoms

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3
Q

What is stroke syndrome?

A

Stroke syndrome is the constellation of signs and symptoms produced due to occlusion or damage of an artery supplying part of the brain

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4
Q

What are the two main types of stroke?

A
  • Ischaemic (85%)
  • Haemmorhagic (10%)
  • Other – sissection, venous sinus thrombosis (5%)
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5
Q

In a stroke, what are the possible locations where the clot could have come from?

A
  • Brain
  • Carotid arteries
  • The vertebral / basilar arteries
  • Aorta
  • Heart
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6
Q

Provide four possible conditions which could lead to blood clots arising from the heart and causing a stroke

A
  • Atrial Fibrillation
  • Valvular disease / prosthetic valves
  • Septic emboli (endocarditis)
  • Intra-cardiac thrombus
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7
Q

Identify three unusual conditions which could lead to a stroke

A
  • Vasculitis
  • Sickle cell anaemia
  • Cocaine (coke stroke)
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8
Q

Which part of the brain does the anterior cerebral artery supply?

A

The anterior cerebral artery supplies the medial aspects of the frontal and parietal lobe and the anterior part of corpus callosum

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9
Q

What does the part of the brain supplied by the ACA do?

A
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10
Q

How could an anterior cerebral artery stroke affect the parietal lobe and corpus callosum?

A
  • Corpus callosum – split brain syndrome, alien hand syndrome
  • Parietal lobes – loss of voluntary control of micturition
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11
Q

How would a patient present with a left ACA stroke?

A
  • Sensory – contralateral loss of all sensory modalities in the lower limb
  • Motor –contralateral paralysis in lower limb more so than upper limb (initially flaccid paralysis then spasticity, UMN signs)
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12
Q

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

A

Majority of the hemisphere:

  • Basal ganglia
  • Internal capsule
  • Macular cortex
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13
Q

What would be the result of a main trunk occlusion in the middle cerebral artery?

A

Considerable cerebral oedema:

  • May lead to coma/death
  • Malignant MCA
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14
Q

What does the part of the brain supplied by the middle cerebral artery do?

A
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15
Q

How does a patient present with a left MCA stroke?

A
  • Sensory – contralateral loss of all sensory modalities in the upper limb and face
  • Motor – contralateral upper limb and face affected more than lower limb (initially flaccid paralysis then spasticity UMN signs)
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16
Q

What will be affected by an occlusion at arrow 1?

A

Occlusion at this point will affect:

  • Lateral motor cortex – responsible for the face and arm
  • Internal capsule – carries descending motor fibres from the entirety of the motor cortex (face, arm and leg may be affected)
17
Q

What will be affected by an occlusion at arrow 2?

A

Occlusion at this point spares the internal capsule but still damages the lateral motor cortex, thus only the face and arm are affected

18
Q

What are the visual effects of proximal and distal occlusions of the middle cerebral artery respectively?

A
  • Proximal occlusion of MCA leads to contralateral homonymous hemianopia
  • Distal occlusion of the MCA may lead to contralateral homonymous superior or inferior quadrantanopia (rare)
19
Q

How does a middle cerebral artery occlusion affect speech?

A

Symptoms depend on:

  • Dominant hemisphere
  • Which branch of MCA is occluded
20
Q

What happens if the dominant hemisphere (most likely left) is affected by a middle cerebral artery occlusion?

A
  • Global aphasia caused by main trunk occlusion
  • Broca’s (expressive) aphasia
  • Wernicke’s (receptive) aphasia
21
Q

What happens if the non-dominant hemisphere (most likely right) is affected by a middle cerebral artery occlusion?

A
  • Hemispatial neglect
  • Tactile extinction
  • Visual extinction
  • Anosognosia
22
Q

Which part of the brain is supplied by the posterior cerebral artery?

A
  • Occipital lobe
  • Inferior temporal lobe
23
Q

How does a patient present with a PCA stroke?

A

Contralateral homonymous hemianopia with macular sparing

24
Q

Which part of the brain do the cerebellar arteries supply?

A
  • Cerebellum
  • Brain stem
25
Q

What does the part of the brain supplied by the cerebellar arteries do?

A

Cerebellum – plays a role in the coordination, precision and timing of purposeful movement

26
Q

How will a patient present with a cerebellar artery stroke (cerebellar signs)?

A
  • Dysdiadochokinesia
  • Ataxia
  • Nystagmus
  • Intention tremor
  • Slurred speech
  • Hypotonia
27
Q

Account for the variation in presentation of a patient with a cerebellar artery stroke

A

Cerebellar arteries also supply the brainstem:

  • Proximal occlusion may cause brainstem and cerebellar signs
  • Distal occlusion may cause cerebellar signs alone
28
Q

Cranial nerve nuclei reside in brainstem.

In light of this, explain the possible brainstem signs that a patient could present with a cerebellar artery stroke

A
  • Damage to ascending / descending tracts affects contralateral side of body
  • Damage to cranial nerves or their nuclei gives ipsilateral signs
29
Q

The severity of a basilar artery stroke depends on location of occlusion.

What is the presentation for a distal and proximal occlusion respectively?

A
  • Distal occlusion

I. Bilateral occipital lobe infarction

II. Bilateral thalamic infarction

III. Bilateral midbrain infarction

  • Proximal occlusion – ’locked-in-syndrome’ (body + facial muscles paralysed)
30
Q

What part of the brain does the lenticulostriate artery (small branch of the MCA) supply?

A

Internal capsule (amongst other things)

31
Q

What does the internal capsule do?

A

Posterior limb – carries descending motor fibres

32
Q

How does a left lenticulostriate artery stroke present?

A

Pure motor hemiparesis:

  • Isolated contralateral paralysis (initially flaccid followed by spasticity)
  • Involving face, upper limb and lower limb
33
Q

What part of the brain does the thalamoperforator artery (small branch of PCA) supply?

A

Part of the thalamus

34
Q

What does the part of the brain supplied by the thalamoperforator artery do?

A

Thalamus – relays sensory information to the left post-central gyrus (somatosensory cortex)

35
Q

How does a left thalamoperforator artery stroke present?

A

Pure sensory stroke:

  • Isolated contralateral sensory loss of all modalities
  • Involving face, upper limb and lower limb
36
Q

Not every case of dysphasia and/or weakness is a stroke.

Identify four other conditions that mimic the presentation of a stroke

A
  • Hypoglycaemia
  • Epilepsy
  • Migraine (hemiplegic)
  • Intracranial tumours/infections
37
Q

Describe the findings in the following CT scan of the brain

A

Direct visualisation of the clot (hyperdense artery)

38
Q

Describe the findings in the following CT scan of the brain:

A
  • Early parenchymal changes
  • Grey matter becomes hypodense (dark)
  • Loss of grey/white matter differentiation

[AMS] Clinical Neuroscience (21 decks)

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