Session 10: Neurotrauma Flashcards
What is a stroke?
The damaging or killing of brain cells starved of oxygen as a result of the blood supply to part of the brain being cut off
What is transient ischaemic attack?
A stroke that recovers within 24 hours from the onset of symptoms
What is stroke syndrome?
Constellation of signs and symptoms produced due to occlusion or damage of an artery supplying part of the brain
What are the 2 main types of Stroke ?
- Ischaemic
- Haemorrhagic
- Other 5% such as Dissection, Venous Sinus Thrombosis
What is the region of supply of Anterior Cerebral artery?
- Medial aspect of the frontal and parietal lobe
- Anterior part of Corpus Callosum
What function of the part of the brain supplied by the anterior cerebral artery?
- Lowe limb motor functions
- Lower limb sensory functions
- Role in voluntary control of micturition
What is the presentation of a patient with Anterior Cerebral Artery?
- Upper motor neurone signs such as Hypertonic, Hyperreflexia, Clonus (motor)
- Loss of all sensory modalities in the contralateral lower limb
- Loss of voluntary control of micturition due to lack of supply to Paracentral Lobules.
- Split brain syndrome (corpus callosum)
- Alien hand syndrome which is disagreement between two hemispheres. (Corpus Callosum)
What is the Region of supply of the Middle Cerebral artery?
- Majority of the Hemisphere
- Basal ganglia
- Internal Capsule
- Macular Cortex
- Lateral aspects of the Hemisphere
What is the function of the part of the brain supplied by the middle cerebral artery?
- Upper limb motor functions
- Upper limb sensory functions
- Eye sight
- Movement
What is a malignant MCA?
- Main trunk occlusion of the middle cerebral artery
- Causes considerable cerebral oedema
- May lead to coma/death
- Decompression semi hectomy to relieve the pressure compression of the brain
What are the signs of a distal middle cerebral artery stroke?
- Contralateral upper limb and face more affected. Flaccid paralysis followed later by spasticity
- Contralateral loss of all sensory modalities in the upper limb and face
- May lead to contralateral homonymous superior or inferior quandrantopia
What are the signs of a proximal middle cerebral artery stroke?
- Contralateral upper limb and face more affected than lower limb
- Flaccid paralysis followed later by spasticity
- Leg symptoms as the internal capsule is affected
- Contralateral loss of all sensory modalities in the upper limb and face
- Contralateral homonymous hemianopia
- If dominant hemisphere is affected, it causes Global Aphasia (Broca’s and Wernicke’s Aphasia)
- If non-dominant side (right) affected, it causes semi-spatial neglect, tactile extinction, visual extinction and anosognosia
What is Tactile extinction?
Aware of being touched on the contralateral limb but not ipsilateral as well when both are touched
What is anosognosia?
Being without disease knowledge.
What is the region of supply of the posterior cerebral artery and its function?
- Occipital lobe
- Functions for the visual cortex
How does a posterior cerebral artery stroke present?
-Contralateral homonymous hemianopsia with macular sparing
What is the region of supply of the cerebellar artery?
- Pons
- Cerebellum
- Brainstem
What is the function of the regions supplied by the cerebellar artery?
- Plays a role in coordination, precision, timing of purposeful movement
- Corticospinal tract runs in the pons
What is the presentation of the proximal cerebellar artery occlusion?
Brainstem and cerebellar sign.
- Dysdiachokinesia
- Ataxia
- Nystagmus
- Intention tremor
- Slurred speech
- Hypotonia
- Crossed deficits affect face on ipsilateral and rest of the body on the contralateral. Damage to ascending/descending tracts affects contralateral side of the body. Damage to cranial nerve or their nuclei gives ipsilateral signs
What is the region of supply of the Basilar artery and its functions?
Brainstem
- Pons
- Medulla
- Midbrain
What is the presentation of distal basilar artery strokes?
- Bilateral occipital lobe infarction
- Bilateral thalamic infarction
- Bilateral midbrain infarction
What is the presentation of proximal basilar artery stroke?
-Locked in syndrome
What is the region of supply of the lenticulostriate artery and functions of the region?
- Internal capsule
- The posterior limb which carries the descending motor fibres
What is the presentation of lenticulostriate artery?
Isolated contralateral
- Paralysis initially flaccid followed by spasticity. Upper motor signs
- Involving face, upper limb and lower limb
What is the region of supply of the thalamoperforatory artery and the function of this region?
- Part of the thalamus is supplied
- Relays sensory information to the post-central gyrus (somatosensory cortex)
What is the presentation of the thalamoperforatory artery?
-Isolated contralateral sensory loss in all modalities. Involved face, upper limb, and lower limb
What are the stroke mimics?
- Hypoglycaemia
- Epilepsy
- Migraine
- Intracranial tumour/infections
Where has the clot come from to cause a stroke?
- Carotid Arteries
- Vertebral/Basilar arteries
- Atrial Fibrillation
- Valvular disease/prosthetic valves
- Vasculitis
- Sickle cell anaemia
- Cocaine
- Septic Emboli
- Intra-cardiac thrombus
What is affected in an anterior cerebral artery stroke?
- Middle Cerebral Artery
- Anterior Cerebral Artery
What are the clinical feature of a total anterior circulation syndrome?
- Hemiparesis AND
- Higher cortical dysfunction AND
- Homonymous hemianopia
What are the clinical features of partial circulation syndrome?
- Isolated higher cortical dysfunction OR
- Any two of hemianopia, higher cortical dysfunction, hemianopia
What are clinical features of Posterior Circulation Syndrome?
-Isolated hemianopia, Brainstem of Cerebellar syndromes.
Occlusion of vertebral, basilar, cerebellar or PCA vessels
What are Lacunar Stroke syndromes?
- Pure Motor Stoke OR
- Pure Sensory Stroke OR
- Sensorimotor Stroke OR
- Ataxic hemianopia OR
- Clumsy hand-dysarthria
What causes Lacunar stroke syndromes?
Caused by small penetrating artery occlusion, usually in the lenticulostriate branches of MA or supply to brainstem or deep white matter.
What cause Anterior Circulation Syndromes?
- Usually a proximal branch MCA or ICA occlusion for total
- Usually a branch MCA occlusion for partial
What causes Posterior Circulation Syndrome
-Occlusion of vertebral, basilar, cerebellar or PCA vessels
