Stroke Flashcards
WHat is a stroke?
A neurological deficit attributed to an acute focal injury of the CNS by a vascular cause, including cerebral infarction, intreacerebral haemorrhage and subarachnoid haemorrhage
WHat is a TIA?
Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction
What are some of the preliminary exams for stroke diagnosis, what are they used fo?
CHADS2- Atrial fibrillation risks
ROSIER- identifies acutestroke
WHat percentage of strokes is ischaemic?
85%
WHat % of strokes is haemorrhagic?
10%
WHts is an example of an ischaemic stroke?
Thromboemblic
WHat is are examples of haemorrhagc=ic strokes?
Intracerebral
Subarachnoid
What are examples of other strokes?
Carotid artery
Venous sinus thrombosis
Hypoxic brain injury
Which pathologies are more likely to cause a stroke in young?
Vasculitis Thrombophilia Subarachnoid haemorrhage Venous sinus thrombosis Carotid artery dissection
WHat is one reason for carotid artery dissection?
Fibromuscular dyplasia
Which pathologies are more likely to occur in elderly?
Thrombosis in city Author- thromboembolism e.g. carotid arteries Heart emboli CNS bleed Sudden blood pressure drop Vasculitis Venous sinus thrombosis
What are heart emboli associated with?
Atrial fibrillation, infective endocarditis or MI
What are risk factors for stroke?
Hypertension Smoking Diabetes mellitus Heart disease Peripheral arterial disease Post- tia Carotid artery occlusion, carotid bruit Polycthemia vera COCP Hyperlipideamia Excess alcohol Clotting disorders
What does the anterior cerebral artery supply?
Lower limb, motor and sensory
What are the symptoms of anterior cerebral stroke?
Contralateral lower limb weakness Contralateral lower limb sensory deficit Urinary incontinence Split brain syndrome/alien hand syndrome Frontal lobe features
Describe urinary incontinence in ACA
Affects the paraccentral lobule within the cortex that excites the M centres, the micturition centres that then project parasympathetics to the detrusor for contraction
What are the frontal lobe features that can show
Personality changes
Apraxic problems e.g. buttoning shirt- motor planning
Which regions are likely to be affected in a middle cerebral artery stroke?
MCS SUPERIORI
MCA inferior
Lenticulostriate arteries
Internal carotid arteries
Where is a proximal MXA occlusion likely to occur?
Internal carotid
Which areas of the brain does the MCA supply?
Lateral frontal, parietal and temporal lobe
And internal capsule
Why does a a complete contralateral hemi paresis occurs in internal carotid artery stroke?
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
What vision problems would be caused by an MCA stroke?
homonymous hemaniopia
Why is there a homonymous hemaniopia?
Destruction og superior and inferior optic radiation due to affect on parietal and temporal
What are the symptoms of proximal MCA occlusion?
Contralateral hemiparesis
Contralateral sensory deficit
Contralateral homonymous hemaniopia
Which side is more commonly affected?
Right side
What would be a specific symptom if the left side is affected?
Aphasia due to Brocas and Wernickes being located here
If the stroke is in the right side what would be a symptom?
Contralateral hemispatial neglect
What are lenticulostriate artery occlusion stokes also known as?
Lacuna stroke
WHat sort of size of stroke are Lacuna stroke?
Small stokes of 15mls, with only a few mm diameter affected
Why are there a range of possible symptoms of Lacunar strokes?
The symptoms will be specific to where in the internal capsule the blood supply is occluded
WHat does the superior MCA supply?
Parietal lobe and the motor cortex
What does the inferior MCA supply?
Supplies temporal lobe and sensory cortex
Depending on supply which part of language will superior MCA occlusion affect?
Brocas area (expressive) and motor cortex
Depending on supply which part of language will inferior MCA occlusion affect?
Receptive (Wernickes area) and visual radiation
sensory cortex
WHat visual defect occurs in a inferior MCA occlusion?
Contralateral visual field defect but no macular sparing
What does the posterior cerebral artery supply?
Posterioir brain
Thalamus
Midbrain
WHat are the symptoms of posterior cerebral artery strokes
Contralateral homonymous hemaniopia with macular sparing
Contralateral sensory loss ( due to thalamic involvement)
Why is there macular sparing in PCA occlusions?
PCA and MCA both supply the occipital lobe, but its the MCA that supplies the macula
What are the symptoms of cerebellar artery occlusions?
Ipsilateral: D A N I S H Ipsilateral Horners COntralateral sensory
Why are there isilaterak corners syndrome symptoms in cerebellar artery occlusions?
Sympathetics run laterally down brainstem
What two types of Basilar artery occlusions?
Pontine
PCA
WHat are the PCA level symptoms?
Oculomotor
Post cerebral artery problems (DANISH)
Sleep regulation problems
