Stroke Flashcards
Hemispacial neglect involves damage to which area of the brain?
Give three features of hemispatial neglect
Right parietal lobe (inferior parietal lobule)
Tactile extinction
Visual extinction
Anosognosia
Why do you get a contralateral homonymous hemianopia in MCA proximal infarcts?
Due to destruction of superior and inferior optic radiations as they run through the superior temporal and parietal lobes.
What sub cortical structures does the PCA supply?
Thalamus
Midbrain
What is a typical feature seen in brainstem strokes?
What is medial medulla syndrome?
What artery is damaged?
Contralateral long term signs weakness and ipsilateral cranial nerve signs
CNXII palsy ipsilateral
Contralateral motor deficit (corticospinal tracts affected)
Contralateral loss of touch pressure vibration and proprioception (medial leminiscus affected)
Anterior spinal artery
Why can a PICA occlusion lead to horner’s syndrome?
Descending sympathetic fibres are damaged.
What are some signs of top of the basilar syndrome?
Visual and occulomotor defects (pupil)
Behavioural abnormalities
Somnolence, hallucinations and dreamlike behaviour
Motor dysfunction often absent
Where is occlusion seen in locked in syndrome?
What can be said about their ocular movement?
Proximal basilar artery
Preserved but usually only on vertical gaze.
Where should all suspected strokes be admitted to? Why?
Why do nurses do dysphagia screening prior to stroke?
Give two other things nurses in the hyperacute stroke units may do?
Specialist stroke unit
Proven to show increased survival time
More likely to receive measures to reduce aspiration
Receive earlier nutrition
To prevent aspiration pneumoniae
NG tubes
Continence assessment
GCS/ cardiac monitors
How is ICH treated?
When is surgery considered?
Give two ways in which VTE prophylaxis can be commenced?
What is used to control hypertension in stroke setting?
Reversal of coagulopathy (Vit K1/ prothrombin complex for anyone on warfarin)
Lower BP if hypertensive (above 150mmHg)
Mannitol if raised ICP
Haemorrhage with hydrocephalus
Lobar haemorrhage with GCS between 9-12
Cerebellar haemorrhage
Compression stockings
LMWH
Nicardipine
B-blockers - labetalol
What agent is used for intravenous thrombolysis in ischaemic stroke?
What should be done if there is a proximal large vessel occlusion?
What two cases is surgery considered?
Alteplase
Thrombectomy
Malignant MCA syndrome
Obstructive hydrocephalus
What do the inferior and superior branches of the MCA supply respectively?
Superior - lateral frontal lobe + Broca’ s
Inferior - lateral parietal lobe + superior temporal lobe + Wernicke’ s + BOTH optic radiations
Why may cerebellar strokes produce brainstem signs?
Because AICA supply’s pons
PICA supply’s medulla
SCA supply’s midbrain
Why does PCA infarct lead to contralateral sensory loss?
Thalamo-perforator fibres blood flow reduced
Why is motor dysfunction often absent in the case of basillar artery infarct?
Why do you get somnolence, hallucinations and dream like behaviour?
Why do you get oculomotor deficits and visual deficits in top of the basilar syndrome?
Why is consciousness preserved and ooculur movement preserved in locked in syndrome?
Because the posterior cerebral arteries are still receiving blood flow via the posterior communicating arteries allowing blood supply to the cerebral peduncles.
Because brainstem contains centres sleep regulation - reticular activating system etc.
Visual disturbance and occlumotor deficits
Because the PCA is blocked - cant supply the occipital lobe
Basilar sends some branches to the midbrain which contains the occluomotor nuclei
Ocular - because PCA can still supply midbrian nuclei
Consciousness - mid brain reticular formation still getting supply
