Stroke

Question 1

WHat is a stroke?

Answer 1

A neurological deficit attributed to an acute focal injury of the CNS by a vascular cause, including cerebral infarction, intreacerebral haemorrhage and subarachnoid haemorrhage

Question 2

WHat is a TIA?

Answer 2

Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction

Question 3

What are some of the preliminary exams for stroke diagnosis, what are they used fo?

Answer 3

CHADS2- Atrial fibrillation risks

ROSIER- identifies acutestroke

Question 4

WHat percentage of strokes is ischaemic?

Answer 4

85%

Question 5

WHat % of strokes is haemorrhagic?

Answer 5

10%

Question 6

WHts is an example of an ischaemic stroke?

Answer 6

Thromboemblic

Question 7

WHat is are examples of haemorrhagc=ic strokes?

Answer 7

Intracerebral

Subarachnoid

Question 8

What are examples of other strokes?

Answer 8

Carotid artery
Venous sinus thrombosis
Hypoxic brain injury

Question 9

Which pathologies are more likely to cause a stroke in young?

Answer 9

Vasculitis
Thrombophilia
Subarachnoid haemorrhage
Venous sinus thrombosis
Carotid artery dissection

Question 10

WHat is one reason for carotid artery dissection?

Answer 10

Fibromuscular dyplasia

Question 11

Which pathologies are more likely to occur in elderly?

Answer 11

Thrombosis in city
Author- thromboembolism e.g. carotid arteries
Heart emboli
CNS bleed
Sudden blood pressure drop
Vasculitis
Venous sinus thrombosis

Question 12

What are heart emboli associated with?

Answer 12

Atrial fibrillation, infective endocarditis or MI

Question 13

What are risk factors for stroke?

Answer 13

Hypertension
Smoking
Diabetes mellitus
Heart disease
Peripheral arterial disease
Post- tia
Carotid artery occlusion, carotid bruit
Polycthemia vera
COCP
Hyperlipideamia
Excess alcohol
Clotting disorders

Question 14

What does the anterior cerebral artery supply?

Answer 14

Lower limb, motor and sensory

Question 15

What are the symptoms of anterior cerebral stroke?

Answer 15

Contralateral lower limb weakness
Contralateral lower limb sensory deficit
Urinary incontinence 
Split brain syndrome/alien hand syndrome
Frontal lobe features

Question 16

Describe urinary incontinence in ACA

Answer 16

Affects the paraccentral lobule within the cortex that excites the M centres, the micturition centres that then project parasympathetics to the detrusor for contraction

Question 17

What are the frontal lobe features that can show

Answer 17

Personality changes

Apraxic problems e.g. buttoning shirt- motor planning

Question 18

Which regions are likely to be affected in a middle cerebral artery stroke?

Answer 18

MCS SUPERIORI
MCA inferior
Lenticulostriate arteries
Internal carotid arteries

Question 19

Where is a proximal MXA occlusion likely to occur?

Answer 19

Internal carotid

Question 20

Which areas of the brain does the MCA supply?

Answer 20

Lateral frontal, parietal and temporal lobe

And internal capsule

Question 21

Why does a a complete contralateral hemi paresis occurs in internal carotid artery stroke?

Answer 21

Because of the regions that the MCA supplies

Internal capsule is the reason for motor deficits throughout because just parietal would affect just the face and arm

Question 22

What vision problems would be caused by an MCA stroke?

Answer 22

homonymous hemaniopia

Question 23

Why is there a homonymous hemaniopia?

Answer 23

Destruction og superior and inferior optic radiation due to affect on parietal and temporal

Question 24

What are the symptoms of proximal MCA occlusion?

Answer 24

Contralateral hemiparesis
Contralateral sensory deficit
Contralateral homonymous hemaniopia

Question 25

Which side is more commonly affected?

Answer 25

Right side

Question 26

What would be a specific symptom if the left side is affected?

Answer 26

Aphasia due to Brocas and Wernickes being located here

Question 27

If the stroke is in the right side what would be a symptom?

Answer 27

Contralateral hemispatial neglect

Question 28

What are lenticulostriate artery occlusion stokes also known as?

Answer 28

Lacuna stroke

Question 29

WHat sort of size of stroke are Lacuna stroke?

Answer 29

Small stokes of 15mls, with only a few mm diameter affected

Question 30

Why are there a range of possible symptoms of Lacunar strokes?

Answer 30

The symptoms will be specific to where in the internal capsule the blood supply is occluded

Question 31

WHat does the superior MCA supply?

Answer 31

Parietal lobe and the motor cortex

Question 32

What does the inferior MCA supply?

Answer 32

Supplies temporal lobe and sensory cortex

Question 33

Depending on supply which part of language will superior MCA occlusion affect?

Answer 33

Brocas area (expressive) and motor cortex

Question 34

Depending on supply which part of language will inferior MCA occlusion affect?

Answer 34

Receptive (Wernickes area) and visual radiation

sensory cortex

Question 35

WHat visual defect occurs in a inferior MCA occlusion?

Answer 35

Contralateral visual field defect but no macular sparing

Question 36

What does the posterior cerebral artery supply?

Answer 36

Posterioir brain
Thalamus
Midbrain

Question 37

WHat are the symptoms of posterior cerebral artery strokes

Answer 37

Contralateral homonymous hemaniopia with macular sparing

Contralateral sensory loss ( due to thalamic involvement)

Question 38

Why is there macular sparing in PCA occlusions?

Answer 38

PCA and MCA both supply the occipital lobe, but its the MCA that supplies the macula

Question 39

What are the symptoms of cerebellar artery occlusions?

Answer 39

Ipsilateral:
D
A
N
I
S
H
Ipsilateral Horners
COntralateral sensory

Question 40

Why are there isilaterak corners syndrome symptoms in cerebellar artery occlusions?

Answer 40

Sympathetics run laterally down brainstem

Question 41

What two types of Basilar artery occlusions?

Answer 41

Pontine

PCA

Question 42

WHat are the PCA level symptoms?

Answer 42

Oculomotor
Post cerebral artery problems (DANISH)
Sleep regulation problems