Stroke

Question 1

What are the types of cerebrovascular disease?

Answer 1

hemorrhagic stroke (intracerebral and subarachnoid hemorrhage)
ischemic stroke (lacunar, embolism, cryptogenic and arterial thrombotic)

Question 2

What is the most common type of ischemic stroke?

Answer 2

cryptogenic, then lacunar

Question 3

What do lacunar stokes result from?

Answer 3

DM or HTN

Question 4

What are the most common areas affected by lacunar strokes?

Answer 4

Areas most commonly affected include the basal ganglia and internal capsule where all the fibers come together.

Question 5

Types of lacunar strokes:

Answer 5

pure motor hemiplegia: pons or internal capsule
pure sensory: thalmus
ataxic hemiparesis: pons
sensory motor syndrome: internal capsule
dysarthia clumsy hand syndrome: pontine or brainstem lacunes. (a/w slurred speech)

Question 6

Right side of the brain:

Answer 6

creativity
music
spatial orientation
artistic awareness

Question 7

Left side of brain:

Answer 7

reasoning
spoken language
number skills
written language

Question 8

Middle cerebral artery

Answer 8

Left Sided(dominant) lesions present with
Right hemiparesis, arm greater then leg.
Right facial weakness usually involving the lower face. (Central Seventh)
Aphasia- Broca’s, Wernicke’s or global. Broca’s area is located in the inferior frontal lobe and Wernicke’s area in the superior temporal lobe.

Question 9

broca’s aphasia:

Answer 9

nonfluent aphasia where a patient is unable to express his thoughts or name objects with full comprehension.

Question 10

Wernicke’s aphasia

Answer 10

is fluent where a patient is able to speak in full sentences without any meaning -similar to someone speaking a different language.

Question 11

when the mca is affected you look toward the lesion

Answer 11

fact

Question 12

right MCA

Answer 12

Neglect, spatial disorientation.
Apraxia-dressing apraxia
Agnosia-anosognosia,affective agnosia
Left hemiparesis involving arm more then leg.

hemineglect

Question 13

Anterior cerebral artery

Answer 13

Most infarcts affect the contralateral leg.

Predominantly develop opposite leg weakness.

Question 14

Posterior cerebral atery

Answer 14

Infarcts most commonly cause a homonymous hemianopsia contralateral to the artery involved. A patient may complain of inability to see the left side of the world in a right occipital stroke.

Question 15

Basilar Artery Stroke

Answer 15

Basilar Artery supplies the pons and superior and inferior cerebellum. Lesions of the base of the pons may produce a quadraplegia, bilateral face and tongue paralysis and the famous Locked In Syndrome.
These patients can only move their eyes vertically. They are awake but appear in a comatose state and are able to communicate using blinking only.

Question 16

Stroke Risk Factors That Cannot Be Treated

Answer 16

Age
 Sex
 Race
 Prior stroke
 Family history

Question 17

Risk factors for a stoke that can be treated

Answer 17

Hypertension/High Blood Pressure
Heart Disease (atrial fibrillation)
Cigarette Smoking
Transient Ischemic Attacks
Diabetes
Elevated Blood Cholesterol/Lipids
Weight

Question 18

Intravenous TPA (recombinant tissue plasminogen activator)

Answer 18

intravenous rtPA for acute ischemic stroke within the three hour window

Question 19

Intra-arterial tPa

Answer 19

Delivery directly into the clot through the artery.
Benefit:
Dose is decreased
Time window expanded to 6 hours?
Drawback:
Invasive procedure which can only be done if a clot is visible in a large vessel. Not helpful for lacunar strokes.

Question 20

When do you use anticoagulants for strokes?

Answer 20

embolic strokes

Question 21

where does basilar artery strokes look?

Answer 21

away from lesion