Stroke 1

Question 1

What is a stroke ?

Answer 1

• Damage to part of the brain due to the blockage of a blood vessel by thrombus or embolus
• or due to haemorrhage from rupture of a blood vessels

Question 2

Describe the anterior + posterior circulation

Answer 2

• supplies the supratentorial structures except the occipital. Arteries originate from the circle of willis
• supplies posterior portion ( occipital, cerebellum, brainstem)

Question 3

What is the circle of willis?

Answer 3

-anastomosis between 2 vertebral and 2 internal carotid arteries. Gives branches

Question 4

Describe the vascular supply

Answer 4

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Question 5

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Answer 5

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Question 6

Neurological history/examination of stroke

Answer 6

• Motor(clumsy/weak limb)
• Sensory ( loss of feeling)
• Speech ( dysarthria/dysphasia)
• Neglect/visuopatial problems
• Vision: loss in one eye/hemianopia gaze palsy
• ataxia/vertigo/incoordination/nyastagmus

Question 7

Causes of a stroke

Answer 7

-blockage of vessel with thrombus / clot
-disease of vessel wall
-disturbance normal properties of blood
-rupture vessel wall
(haemorrhage)

Question 8

Types of stroke

Answer 8

ischemic(common) + haemorrhagic stroke

Question 9

What is a haemorrhagic stroke/ischemic stroke?

Answer 9

haemorrhagic stroke - BV ruptures and blood leaks into brain tissue > haematoma which will compress and surround surrounding brain tissue
Ischemic stroke - blockage/clot in an artery which reduces blood supply to the brain. Ischemia

Question 10

State the causes of ischaemic stroke

Answer 10

• large artery atherosclerpsis ( eg carotid)
• cardioembolic ( eg atrial fibrilation)
• small artery occlusion ( lacunar)
• undetermined/cryptogenic

Rare causes

• arterial dissection
• venous sinus thrombosis

Question 11

State the causes of haemorrhagic stroke

Answer 11

• primary intracerebral haemorrhage

- secondary haemorrhage ( subarachnoid + atriovenous malformation)

Question 12

symptoms of stroke

Answer 12

-dependent on which artery/area of brain is affected

Question 13

State the stroke subtypes

Answer 13

• total anterior circulation stroke
• partial anterior circulation stroke
• lacunar stroke
• posterior circulation stroke

Question 14

What is a total anterior circulation stroke(TACS)?

Answer 14

• 20 %
• stroke due to occlusion of middle cerebral artery/internal carotid artery
• symptoms include weakness, sensoey deficity, homonymous hemianopia ( loss of vission) + higher cerebral dysfunction ( dysphasia

Question 15

What is partial anterior circulation stroke?

Answer 15

• 35%

- cotyical infarcts involving occlusion of branches of middle cerebral artery

Question 16

What is a cortical stroke?

Answer 16

-stroke that affects the cortex region of the brain

Question 17

What is a lacunar stroke?

Answer 17

• 20%
• stroke that affects small BVs
• 3 types : pure motor, pure sensory, sensorimotor
• often silent/undiagnised

Question 18

What are pure motor/sensory, sensorimotor strokes?

Answer 18

Pure motor
- complete/incomplete weakness of 1 side involving the whole of 2 of 3 body areas( face/arm/leg)

Pure sensory
-sensory symptoms and/ore signs ‘’ ‘’

Sensorimotor
-combination of both

Question 19

What is a posterior circulation stroke?

Answer 19

25% of stoke

• affects brain stem, cerebellar/occipital lobes
• complex presentation that may include:
• bilateral motor/sensory deficit, disordered conjugate eye movement, isolated homonymous hemianopia, ipsilateral cranial nerve palsy with contralateral motor/sensory deficity.
• coma, disordered breathing, tinnitus, vertigo’s, hornoers syndrome

Question 20

Risk factors for stroke

Answer 20

• HBP, atrial fibrilation (modifiable)

- age, race, FMX ( non modifiable)