Stroke Flashcards

1
Q

Define a stroke

A

A neurological deficit

Attributed to acute focal injury of CNS

By vascular cause (cerebral infarction/ intracerebral haemorrhage/ subarachnoid haemorrhage)

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2
Q

Define a TIA

A

Transient episode of neurological dysfunction

Caused focal brain/ spinal cord/ retinal ischaemia

WIThOUT acute infarction

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3
Q

How common are the causes of strokes? Common causes in the young and old

A

85% ischaemic (thromboembolic)

10% haemorrhagic (intracerebral/ subarachnoid)

5% other (dissection/ venous sinus thrombosis/ hypoxic Brain injury)

Young: vasculitis, thrombophilia, subarachnoid haemorrhage, venous sinus thrombosis, carotid artery dissection

Old: thrombosis in situ, athero- thromboembolism, heart emboli, CNS bleed, sudden BP drop >40mmHg, vasculitis, venous sinus thrombosis

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4
Q

Risk factors for strokes

A
Hypertension
Smoking 
DM
Heart disease
Peripheral arterial disease
Post TIA
Carotid artery occlusion 
Polycythaemia Vera
COCP
Hyperlipidemia 
XS alcohol
Clotting disorders
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5
Q

What are the symptoms of an anterior cerebral artery stroke and why?

A

Contralateral lower limb: weakness & sensory deficit - motor homunculus (along precentral gyrus of frontal lobe) & sensory (along postcentral gyrus of parietal lobe) similar areas

Split brain syndrome/ alien hand syndrome (rare) - corpus callosum

Urinary incontinence - supplies cortex which sends excitatory/ inhibitory neurones to M centre to decide whether to void

Frontal lobe features e.g. personality changes/ problems with motor planning

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6
Q

Which general areas of the brain are supplied by which cerebral arteries?

A

ACA - supplies large medial area

MCA - large lateral area

PCA - inferior and posterior sections

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7
Q

What are the symptoms of a proximal middle cerebral artery stroke and why?

A

Affects everything downstream so: lenticulostriate arteries, MCA inferior division, MCA superior division

Complete contralateral hemiparesis (flaccid or spastic) - supplies internal capsule (face, arm , leg, chest fibres)

Contralateral sensory loss more likely face & arm - lateral primary sensory cortex (sensory homunculus)

Contralateral homonomous hemianopia- superior (temporal lobe) & inferior (parietal lobe) optic radiation

Speech difficulties - Broca’s area (frontal) & Wernicke’s area (tempero- parietal lobe) e.g. left sided stroke = aphasia

(Left sided) contralateral hemispacious Neglect (more common if right parietal lobe affected as left has bilateral supply)

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8
Q

What are the symptoms of a singular lenticulostriate artery stroke and why?

A

Lacunar strokes
Very small

Normally only motor or sensory deficit
Or mixed

Internal capsule affected

V specific

No cortical symptoms

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9
Q

What are the symptoms of a distal middle cerebral artery stroke and why?

A

Superior division -> lateral frontal lobe
Broca’s area - expressive aphasia (if left affected)
Motor cortex - contralateral leg and arm weakness

Or

Inferior division -> superior temporal lobe & lateral parietal
Wernicke’s area - receptive aphasia (if left side affected)
PSC - contralateral sensory changes face/ arm
Both Optic radiations - contralateral visual field without macular sparing often homonymous hemianopia

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10
Q

What are the symptoms of a posterior cerebral artery stroke and why?

A

Supplies thalamus and midbrain

Contralateral homonomous hemianopia WITH macular sparing - (Dual blood supply from MCA)

Contralateral sensory loss - thalamic involvement (internal capsule)

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11
Q

What are the symptoms of a cerebellar artery stroke and why?

A

Ipsilateral DANISH signs (dysdiadochokinesia, ataxia, nystagmus, intention tremor, slurred/ staccato speech, hypotonia) - ipsilateral spinocerebellar tracts

Ipsilateral Horner’s syndrome (miosis, ptosis, anhidrosis) - supply Brainstem as loop around cerebellum - sympathetic involvement

Contralateral sensory deficit - sensory pathways run laterally through brainstem pre-decussation

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12
Q

What are the symptoms of a basilar artery stroke and why?

A

Either at level of pontine arteries or more commonly PCA

At PCA level - occulomotor nuclei
- visual & occulomotor defects (could prevent blood flowing into PCA -> occipital lobe -> cortical blindness

Sleep regulation problems - sleep centres in midbrain

If occludes 2 pontine arteries bilaterally - locked in syndrome (complete loss of movement limbs, preserved ocular movement as occulomotor nuclei above, preserved consciousness midbrain reticular formation intact)

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13
Q

What is the Bramford / Oxford classification for strokes?

A

TACS - total anterior circulation stroke
(large cortical stroke in middle/ anterior cerebral artery areas)

PACS - partial anterior circulation syndrome
(Cortical stroke in middle/ anterior cerebral artery areas)

POCS - posterior circulation syndrome

LACS - lacunar syndrome
(Subcortical stroke due to small vessels disease, no evidence higher cerebral dysfunction)

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14
Q

Criteria for TACS

A

Total anterior circulation stroke
All 3 of:

Unilateral weakness (+/- sensory) face/ arm/ leg

Homonymous hemianopia

Higher cerebral dysfunction (dysphasia/ aphasia or visuospatial disorder)

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15
Q

Criteria for PACS

A

Partial anterior circulation stroke
2 of:

Unilateral weakness (+/- sensory) face, arm, leg

Homonymous hemianopia

Higher cerebral dysfunction (dysphasia/ aphasia or visuospatial disorder)

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16
Q

Criteria for POCS

A

Posterior circulation stroke
One of:

CN palsy & contralateral motor/ sensory deficit

Bilateral motor/ sensory deficit

Conjugate eye movements disorder

Cerebellar dysfunction

Isolated homonymous hemianopia (with macular sparing)

17
Q

Criteria for LACS

A

Lacunar syndrome
One of:

Pure sensory deficit

Pure motor deficit

Sensori- motor deficit

Ataxic hemiparesis

18
Q

Key rule for Brainstem pathology

A

Ipsilateral CN signs +

Contralateral sensory & motor tract deficits