Stroke Flashcards
Stroke : Blood supply of brain - Internal carotid artery
Internal carotid artery - gives off two branches
1 . Middle cerebral artery which supplies
Lateral portion of;
* Frontal lobe
* Temporal lobe
* Parital lobe
2 . Anterior cerebral artery which supplies
Medial portion of
* Frontal lobe
* Parietal lobe
Stroke : Blood supply of brain - Vertebral artery
Vertebral artery branches to form;
1 . Basilar artery
supplying the
* Cerebellum
* Brainstem
2 . Basilar artery branches off to give : L+R Posterior cerebral arteries
which supply the;
* Occipital lobe
* Temporal lobe
* Thalamus
Stroke : Middle cerebral artery stroke
Middle cerebral artery - branch of the Internal carotid supplies;
1 . Lateral Frontal lobe
-Pre-central gyrus controlling voluntary muscle movements of the upper limb and facial motor movement
-Contains Broca’s area - Speech production
* Contralateral hemiparesis of Upper limbs
* Facial droop
* Aphasia
2 . Lateral Parietal lobe
-Post central gyrus responsible for sensation
* Contralateral upper limp sensory dysfunction
3 . Lateral Temporal lobe
-Wernicke’s area : language comprehension
* Difficulty in language comprehension
Anterior cerebral artery : Anatomy of blood supply
1 . Medial Frontal lobe
Controls lower limb movement and executive functioning
2 . Medial Parital lobe
Controls lower limb sensation
Stroke : Anterior cerebral artery stroke
1 . Medial Frontal lobe
Controls lower limb movement and executive functioning
* Contralateral lower limb weakness
* Cognitive and behavioral changes
2 . Medial Parital lobe
Controls lower limb sensation
* Contralateral lower limb sensory dysfunction
Stroke : Posterior cerebral artery blood supply
Branch of the Basilar artery which stems from the vertebral artery supplies
1 . Occipital lobe - Visual cortex
2 . Thalamus - Relays motor and sensory signals to the cerebral cortex.
3 . Temporal lobe - Hippocampus, language processing area
4 . Midbrain - region of the brainstem, relays centre for visual, auditory and motor pathways
* Contains oculomotor/Trochlear nuclei and modulates eye movement
- Reticular activating system : controls wakefulness and alertness
Stroke : Posterior cerebral artery stroke
Branch of the Basilar artery which stems from the vertebral artery supplies
1 . Occipital lobe - Visual cortex
* Homonymous Hemianopia and Cortical Blindness
2 . Thalamus - Relays motor and sensory signals to the cerebral cortex.
3 . Temporal lobe - Hippocampus, language processing area
* Speech and language disturbance - difficulty finding words, speech comprehension difficulties
4 . Midbrain - region of the brainstem, relays centre for visual, auditory and motor pathways
-Contains oculomotor/Trochlear nuclei and modulates eye movement
* Diplopia and Eye movement abnormalities
-Reticular activating system : controls wakefulness and alertness
* Altered levels of consciousness
Stroke : Cerebellar artery stroke
Posterior inferior cerebellar artery stroke
* Anatomy : Branch of the vertebral artery, supplies inferior, posterior and lateral aspect of the cerebellum
Cerebellum : contains
- Lateral hemisphere : Movement coordination, balance and fine tuning motor controls
-> Ataxia and loss of coordination, difficulties with gait, posture and fine motor tasks
- Coordination of speech and articulation
-> Dysarthria
2 . Trigeminal nucleus : Facial sensation and swallowing
-> Ipsilateral facial pain
Anterior inferior cerebellar artery stroke
* Same as above but also supplies;
1. Cochlear nucleus - hearing
-> Sudden sensorineural hearing loss
3. Vestibular nucleus — maintaining balance and coordinating eye movement
-> Vertigo with N+V
-> Nystagmus
Stroke : Cerebellar artery blood supply
Posterior inferior cerebellar artery stroke
* Anatomy : Branch of the vertebral artery, supplies inferior, posterior and lateral aspect of the cerebellum
Cerebellum : contains
1. Lateral hemisphere : Movement coordination, balance and fine tuning motor controls
- Coordination of speech and articulation
2 .** Trigeminal nucleus : Facial sensation and swallowing**
Anterior inferior cerebellar artery
* Same as above but also supplies;
1. Cochlear nucleus - hearing
- Vestibular nucleus — maintaining balance and coordinating eye movement
Stroke : Lacunar stroke
1 . Internal capsule :
-Facilitates communication between the cerebral Cortex and the Spinal Chord
-Contains ascending and descending motor and sensory fibres
* Pure motor stroke : Sudden weakness affecting one side of the body
* Ataxic hemiparesis : Weakness or lack of coordination on one side of the body
2 . Thalamus : relay station for sensory information.
-Direct sensory input to cortical areas for further processing
* Pure sensory stroke : Sudden onset sensory deficit affecting one side of the body
Stroke : definition
Cerebrovascular accidentsare either:
* Ischaemic stroke : Ischaemiaorinfarctionof the brain tissue secondary to a disrupted blood supply
* Haemorrhagic stroke : Intracranial haemorrhage, with bleeding in or around the brain
Stroke : Assessment
ROSIER SCORE
* Exclude hyperglycaemia
Stroke likely if >0
New, acute onset of: (+ 1 point for each )
1. asymmetric facial weakness
2. asymmetric arm weakness
3. asymmetric leg weakness
4. speech disturbance
5. visual field defect
Lose 1 point for;
1. Loss of consciousness or syncope
2. Seizure activity
Stroke : Investigation
- Contrast CT scan
* Differentiate between Haemorrhagic vs Ischaemic stroke
Ischaemic Stroke : Acute management
- Thrombolysis with alteplase
Indic : < 4.5 hours of onset - Thrombectomy
Indication : Prefunctional status (<3 in Rankin scale, >5 NIHSS) - Carotid Endartectomy
Indication :
* Acute troke
* TIA in carotid territory
* Carotid stenosis >70% or symptomatic
* NOT severely disabled
Acute Ischaemic stroke : PACS mx
Posterior anterior circulation stroke
- Posterior anterior circulation stroke
{Confirmed on CT/MRI scan
* < 4.5 hour onset : Thrombectomy + Thrombolysis
* < 6 hour onset : Thrombectomy
- < 24 hours : Thrombectomy
Indic : If potential to salvage brain tissue in limited infarct
