Stroke

Question 1

Regions middle cerebral artery supplies

Answer 1

Lateral side of frontal, parietal, and temporal lobes

Question 2

What symptoms occur with Middle cerebral artery occlusion?

Answer 2

• Weakness and sensory deficits in the opposite side
• Face and arms more affected than legs
• Homonymous hemianopsia w/ipsilateral gaze deviation (“looking at their lession”)

Question 3

What happens with middle cerebral artery occlusion on the side of the dominant cerebral hemisphere?

Answer 3

Aphasia or problems speaking

Question 4

What happens with middle cerebral artery occlusion on the side of the nondominant cerebral hemisphere?

Answer 4

Contralateral hemineglect

Question 5

Regions anterior cerebral artery supplies

Answer 5

Anterior and medial aspects of the frontal, parietal, and temporal lobes

Question 6

Anterior cerebral artery occlusion symptoms

Answer 6

• Weakness and sensory deficits on the opposite side
• More likely to affect the legs
• Associated with frontal lobe problems (personality changes)

Question 7

Regions lenticulostriate arteries supply

Answer 7

Deep structures of the brain

Question 8

Lenticulostriate (lacunar stroke) symptoms

Answer 8

-Lack of cortical signs (no aphasia, neglect, or visual field cuts)

Question 9

Pure motor lenticulostriate stroke symptoms and location

Answer 9

Posterior limb of the internal capsule.

Hemiparesis of legs, arms, and face on one side (disrupion in the corticospinal an corticobulbar tracts)

Question 10

Pure sensory lenticulostriate stroke symptoms and location

Answer 10

Lateral thalamus. Numness in legs, arms, face of contralateral side of the body

Question 11

Vertebral artery supply

Answer 11

Inferior cerebellum and lateral medulla

Question 12

Cerebellar infarct symptoms

Answer 12

-Cerebellar dysfunction (ataxia, vertigo, blurred vision, nystagmus, vomiting, postural instability)

Question 13

Lateral medullary infarct (Wallenburg syndrome) symptoms

Answer 13

-“Crossed symptoms” Numbness on one side of fase and opposite side of body due to ipsilateral cranial nerve damage and damge to sensory fibers where they cross on the contralateral side.

Question 14

Basilar artery supply

Answer 14

Rostral brainstem and occipital lobes

Question 15

Basilar artery stroke symptoms

Answer 15

CN palsies. Can causes gaze issues, hemianopsia, miosis. More extensive occlusions can cause damage to the reticular activating system–can cause altered level of consciousness and damage to other CN

Question 16

What is unique about basilar artery stroke?

Answer 16

One of the few types of stroke that can cause loss of consciousness

Question 17

Posterior cerebral supply

Answer 17

Occipital lobes

Question 18

Symptoms of posterior cerebral stroke

Answer 18

Homonymous hemianopsia of contralateral vision field. Often have macular sparing and may struggle naming colors. Nondominant hemisphere infarct can result in neglect of affected vision field.

Question 19

Intracerebral hemorrhage

Answer 19

• Hypertension
• Usually in deep structures of the brain
• Less common in cerebral cortex

Question 20

Subarachnoid hemorrhage

Answer 20

“Worse headache of my life” or thunderclap headache. Often have nausea, nuchal rigidity, photophobia, alterled level of consciousness, vomiting. May have VIth nerve palsy or IIIrd nerve palsy from intracranial pressure.

Question 21

Most common cause of subarachnoid hemorrhage?

Answer 21

Trauma

Question 22

Most common non-traumatic cause of subarachnoid hemorrhage?

Answer 22

Berry aneurysm

Question 23

Ischemic stroke

Answer 23

Can be from thrombosis or embolism.
Inadequate oxygen delivery occurs. Neuronal cell death begins within 4 minutes. Sudden onset focal neurological deficits (usually without headache).

Question 24

First thing to do when stroke suspected?

Answer 24

Non-contrast head CT.

Question 25

What is CT ideal for identifying

Answer 25

Hemorrhagic stroke.

Question 26

What is the most sensitive test for ischemic stroke?

Answer 26

MRI

Question 27

When is cerebral angiography indicated?

Answer 27

To evaluate patients w/ischemic strokes in verebrobasilar distribution and patients with subarachnoid or intraparenchymal hemorrhages.

Question 28

Nonmodifiable risk factors

Answer 28

Age, race, ethnicity, hereditary

Question 29

Modifiable risk factors

Answer 29

Hypertension, DM, lipids, atrial fibrillation management, smoking.

Question 30

TPA mechanism of action

Answer 30

Enhances conversion of plasminogen to plasmin by binding to fibrin. Initiates fibrinolysis

Question 31

What does TPA do after stroke?

Answer 31

Helps restore patency to the thrombosed vessels

Question 32

When does TPA have to be administered by?

Answer 32

Within 3-4 1/2 hours of onset.