Stroke

Question 1

Definition

Answer 1

Interrupted blood flow to the brain caused by a thrombus/ embolism or by a haemorrhage
WHO: sudden neurological damage lasting more than 24 hours

Question 2

Aetiology

Answer 2

• Blockage of blood vessel due to thrombus/clot
• Change in properties of the blood
• Vessel rupture
• Disease of vessel wall

Question 3

Two different types of stroke

Answer 3

• Ischaemic stroke- thrombus/embolism

- Haemorragic stroke- blood leaks into brain tissue

Question 4

Different causes of Ischaemic stoke

Answer 4

• carotid stenosis- clot at bifurcation. Related to carotid disease where plaque ruptures into carotid artery and makes its way to the brain
• cardioembolism- related to AF
• small vessel blockage/lacunar
• carotid dissection i.e. tear in wall -RARE

Question 5

Blood supply to the brain:

-where do they supply

Answer 5

TWO Internal carotid:
-cortical deep white matter- parietal, frontal and temporal lobes
-splits into Left and Right middle cerebral arteries and anterior cerebral arteries
-anterior cerebral arteries connected via communicating anterior artery
-communicating posterior cerebral arteries also formed
2 Vertebral arteries:
-become basilar artery
-separates to form L+ R posterior cerebral arteries
-supplies occipital lobe, brain stem and cerebellum

Question 6

TAC

Answer 6

Total anterior circulation

• 20% of strokes
• motor weakness
• sensory weakness
• homonyos hemianopia
• higher cerebral dysfunction
• occlusion of middle cerebral artery or internal carotid

Question 7

PAC

Answer 7

partial anterior circulation

• 35% of strokes
• 2/3 rd of symptoms of TAC e.g. 1 limb +face or hand
• Either sensory or motor abilities affected
• branches of middle cerebral artery affected

Question 8

Lacunar

Answer 8

Middle cerebral artery
Complete/incomplete weakness of one side of the body
Damage brain surrounded by cysts which look like lakes

Question 9

POC

Answer 9

Posterior circulation

Question 10

Circle of willis

Answer 10

Allows circulation between vertebral system and carotid system
Allows blood flow to be maintained when there is an obstruction

Question 11

What does the brain stem control

Answer 11

• heart rate
• blood pressure
• breathing
• GI functions
• consciousness

Question 12

Ischaemic core and Ischaemic penumbra

Answer 12

Ischaemic core: part of brain which will die

Ischeamic penumbra: part of brain which may survive due to collateral circulation

Question 13

Symptoms

Answer 13

Face dropping
Arm weakness
Slurred speech
Time

Question 14

Diagnosis

Answer 14

CT
MRI
CT angiogram 
Carotid doppler to look at carotids
Blood tests

Question 15

Risk factors

• modifiable
• non-modifiable

Answer 15

Modifiable:
-smoking
-BP
Non-modifiable:
-Age
-Race
-Family history