stroke

Question 1

stroke defination

Answer 1

Acute onset of
Focal neurological symptoms/signs due to
Interruption of blood supply

lasts longer than 24 hours or leads to death.

Question 2

TIA

Answer 2

same thing just <24h

Question 3

RF

Answer 3

oral contraceptive pill
undiagnosed AF

Question 4

main causes

Answer 4

ischaemic most common- large artery disease, cardioembolic, lacunar

haemorrhagic- hypertension, cerebral amyloid angiopathy

Question 5

lacunar

Answer 5

Caused by occlusion of a single deep penetrating artery. Affect 2 any two of face arm and leg

basal ganglia, thalamus, white matter) and in the brain stem.

best prognosis

Question 6

cerebral amyloid angiopathy

Answer 6

accumulation of amyloid beta-peptide within the leptomeninges and small/medium-sized cerebral blood vessels.

leptomeninges- arachnoid and pia

Question 7

Penumbra

Answer 7

area of brain with reduced cerebral blood flow, but also getting supply of O2 and glucose from collateral arteries.
At risk of progressing to infarction but is still salvageable if reperfused

Question 8

Ischaemic Core

Answer 8

area of brain which have developed necrosis. Cerebral blood flow < 20%.q

Question 9

Ischaemic Cascade

Answer 9

Switch from Aerobic to anaerobic metabolism-

Accumulation of lactic acid

Na/K channel dysregulation – cytotoxic oedema

Na/Ca channel dysregulation –increase Ca within neuron:
Excitotoxicity
Degradative enzymes
Formation of radicals

Mitochondrial apoptotic factors

Question 10

vasogenic oedema

Answer 10

starts 4-6 hours after ischaemia

Basement membrane becomes leaky and things comes out so oedema, mass effect, pushes brain oppostie way and down which is fatal

Question 11

post stroke there is

Answer 11

inflammation

Question 12

TOAST 1

Answer 12

Large Artery Atherosclerosis

Atherothrombosis or thromboembolism

Question 13

TOAST 2

Answer 13

Cardioembolic- any cardio cause e.g. atrial myxoma/tumur of atria, endocarditis

Question 14

TOAST 3

Answer 14

Small artery disease

lacunar stroke

Caused by lipohyalinosis (thickened vessel wall with lumina narrowing)- hypertension/diabetes

Question 15

TOAST 4

Answer 15

other

vasculitis
genetic microangiopathy

SUSAC syndrome (retino-cochlea-cerebral vasculopathy)

hypercoaguble states/antiphospholipid syndrome

COVID/HIV

recreational drugs

pregnancy

Question 16

TOAST 5

Answer 16

unknown

Question 17

Anterior cerebral artery/Middle cerebral artery symptoms

Answer 17

Hemiparesis- weakness/inability to move one side

Hemisensory loss

Hemianopia (affects optic tract)

Dysphasia (left MCA)- speech

Sensory/visual inattention/neglect (right MCA)

Question 18

Lacunar syndromes (perforating arteries) symptoms

Answer 18

anterior

Pure motor stroke
Pure sensory stroke
Sensorimotor stroke

Clumsy handdysarthria(slight weakness and clumsiness of the hand with slurred speech)

Ataxic hemiparesis (ataxia and usually mild hemiparesis affecting the same side)

Question 19

Posterior circulation supplies

Answer 19

Comprised of 2 vertebral arteries and basilar artery – become posterior cerebral artery

Supply occipital cortex – hemianopia

Supply brainstem and cerebellum-

Question 20

Posterior circulation symptoms

Answer 20

Supply brainstem and cerebellum-

Hemiparesis/hemisensory loss (involvement of ascending and descending tracts)

Ataxia- balance, coordiantion

Dysarthria- speech due to muscle weakness

Due to cranial nerve nuclei involvement – vertigo, diplopia, facial nerve palsy, tongue palsy, dysphagia

Bilateral symptoms – basilar artery syndrome

Question 21

Total Anterior Circulation Syndrome (TACS)

Answer 21

Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss Homonymous Hemianopia
Cortical signs (dysphasia, neglect etc)

worst type- bad prognosis

Question 22

Partial Anterior Circulation Syndrome (PACS)

Answer 22

2 out of 3 features present in a TACS or;
Isolated Cortical Dysfunction such as dysphasia or;
Pure motor/sensory signs less severe than in lacunar syndromes (eg monoparesis).

half patients recover

Question 23

Posterior Circulation Syndrome (POCS)

Answer 23

Cranial nerve palsies
Bilateral motor and/or sensory deficits
Conjugate eye movement disorders Isolated homonymous hemianopia Cortical blindness
Cerebellar deficits without ipsilateral motor/sensory signs

good prognosis