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Clinical Neuroscience > Stroke > Flashcards

Stroke Flashcards

1
Q

Strokes occur when blood supply to part of the brain is cut off.

Compare Stroke and TIA

A

Stroke- Symptoms and signs persist for >24h

TIA- Completely resolve within 24h

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2
Q

What are the 3 types of Stroke

What percentage of all strokes do these make up?

A
  • Ischaemic, 85% (Thromboembolic)
  • Haemorrhagic 10% (Intracerebral, Subarachnoid)
  • Other (5%)
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3
Q

What are 3 causes of non-ischaemic, non-haemorrhagic stroke

A
  • Dissection (separation of walls of artery, can occlude branches)
  • Venous Sinus Thrombosis (Vein occlusion-> Backpressure + Ischaemia)
  • Hypoxic brain injury (after cardiac arrest)
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4
Q

What are the 2 main principles of emergency stroke treatment?

A
  • Are they within the window for thrombolysis (<4 hrs)

- Head CT to determine if it is a bleed (Cannot do thrombolysis if there is a bleed)

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5
Q

How does an acute stroke look on a head CT?

A
  • Ischaemic area not visible early on

- Bleed shows up as bright white area (maybe with mass effect)

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6
Q

An MRI is sometimes performed to diagnose acute stroke.

How does it look?

A

Ischaemia shows up as a high signal area

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7
Q

What do the clinical features of a stroke depend on?

A

Whether Anterior or Posterior circulation is affected, AND whether pathology is in Proximal or Distal territory

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8
Q

List 6 signs of ACA infarct

A
  • Contralateral lower limb weakness (Worse than upper limb + face as ACA supplies medial cortex)
  • Contralateral sensory changes (same pattern as motor deficit)
  • Urinary Incontinence
  • Apraxia (Inability to complete motor planning, often caused by left frontal lobe damage)
  • Dysarthria/ Aphasia (Unusual in ACA infarct)
  • Split brain/ Alien hand syndrome (Involvement of Corpus Callosum)
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9
Q

In ACA infarct, why do you get Urinary incontinence?

A

As paracentral lobules are affected

most medial part of sensory/ motor cortices and supply perineal area

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10
Q

Describe briefly the range of effects and mortality of a MCA infarct

A
  • Very widespread effects (as MCA supplies large area of brain)
  • 80% mortality if main MCA trunk affected, due to Cerebral Oedema
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11
Q

What can occur in an MCA infarct if the vessels in the infarcted area break down?

A

Haemorrhagic transformation

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12
Q

What are the 3 points of the MCA where an occlusion can occur

A
  • Proximal (before deep branches come off)
  • Leneticulostriate arteries (Lacunar strokes)
  • Distal branches (Superior or inferior divisions)
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13
Q

If the Proximal MCA is occluded, all the the branches will be affected

List 5 main signs of a Proximal MCA occlusion

A
  • Contralateral full hemiparesis (Internal Capsule affected so Face, Arm, Leg fibres all affected)
  • Contralateral sensory loss (Face, Arm usually, but legs too if IC affected)
  • Contralateral Homonymous Hemianopia WITHOUT macular sparing, as both S+I Optic Radiations affected.
  • Aphasia (Global, if left hemisphere affected)
  • Contralateral neglect (Usually if right parietal lobe affected, normal visual fields)
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14
Q

List 3 additional/ possible signs of a Proximal MCA infarct

A
  • Tactile extinction (if you touch each side at the same time, doesn’t feel the affected side)
  • Visual extinction (doesn’t see half of frontal view)
  • Anosognosia (doesn’t acknowledge that they had a stroke)
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15
Q

Leneticulostriate artery occlusions/ Lacunar strokes cause destruction of small areas of Internal Capsule and Basal ganglia

What’s their defining feature in comparison to a Proximal MCA infarct

A

Lacunar strokes do not cause cortical features (neglect or aphasia)

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16
Q

What are 3 types of signs causes by Lacunar strokes?

A
  • Pure motor (damage to motor fibres through IC)
  • Pure sensory (damage to sensory fibres through IC)
  • Sensorimotor (Infarct at boundary between M and S fibres)
17
Q

What are the 2 branches of the distal MCA?

What regions do they supply?

A

Superior division ;

  • Supplies lateral Frontal lobe
  • Including Motor Cortex and Broca’s Area

Inferior division;

  • Supplies Lateral Parietal and Superior Temporal lobes
  • Including Sensory Cortex, Wernicke’s Area and both Optic Radiations
18
Q

Compare the signs of an occlusion of the Superior and Inferior divisions of the distal MCA

A

Superior;

  • Contralateral Face + Arm weakness
  • Expressive Aphasia if left hemisphere affected

Inferior;

  • Contralateral sensory change in Face + Arm
  • Receptive aphasia if left hemisphere affected
  • Contralateral Homonymous Hemianopia

(More distal occlusions can have more specific effects e.g Broca’s area affected but not Motor cortex)

19
Q

List 2 signs of a PCA infarct

A
  • Contralateral sensory loss (thalamus damage)

- Contralateral Homonymous Hemianopia WITH macular sparing (collateral MCA supply)

20
Q

List 4 SYMPTOMS of Cerebellar Infarcts

Not the Ipsilateral signs- DANISH

A
  • Nausea
  • Vertigo/ Dizziness
  • Vomiting
  • Headache
21
Q

List 3 types of signs of Cerebellar infarcts

A
  • DANISH
  • Ipsilateral Brainstem signs (Cerebellar arteries supply brainstem)
  • Contralateral Sensory deficit/ Ipsilateral Horner’s
22
Q

What are 2 typical features of Brainstem strokes?

A
  • Contralateral limb weakness

- Ipsilateral cranial nerve signs

23
Q

The Basilar artery can be occluded Proximally or Distally.

Explain a major consequence of a BA occlusion.

A

Can cause sudden death as the BA supplies the brainstem

24
Q

List 3 signs of a Distal/ Superior Basilar Artery Occlusion

A
  • Visual and Oculomotor defects (BA sends branches to Midbrain, where CNIII nucleus is)
  • Behavioural abnormalities
  • Somnolence, Hallucinations, Dream like behaviour

(Motor dysfunction often absent if cerebral peduncles can get blood from PCAs which are filled via Post. Communicating Arteries)

25
Q

List 2 signs of a Proximal/ Inferior Basilar Artery Occlusion

A
  • Occlusion of Pontine Branches on each side

- Locked in syndrome (eyes still move because midbrain gets blood from PCAs from Posterior Communicating Arteries)

26
Q

What is the Bamford/ Oxford classification?

A

A tool used to quickly diagnose strokes

27
Q

What are the 4 Bamford/ Oxford Stroke Classifications?

A
  • TACS (Total Anterior Circulation Stroke)
  • PACS (Partial Anterior Circulation Syndrome)
  • POCS (Posterior Circulation Syndrome)
  • LACS (Lacunar Syndrome)
28
Q

What do Ipsilateral cranial nerve signs + contralateral sensory/ motor tract deficits suggest?

A

Brainstem pathology

29
Q

Describe the diagnostic criteria for a Total Anterior Circulation Stroke (TACS)

A

All 3 of;

  • Unilateral weakness and/or sensory loss of Face,Arms,Leg
  • Homonymous Hemianopia
  • Higher cerebral dysfunction (Dysphasia, Visuospatial disorder)
30
Q

Describe the diagnostic criteria of a Partial Anterior Circulation Stroke (PACS)

A

Two of;

  • Unilateral weakness and/or sensory deficit of Face,Arms,Leg
  • Homonymous Hemianopia
  • Higher cerebral dysfunction (Dysphasia, Visuospatial disorder)
31
Q

Describe the diagnostic criteria of a Posterior Circulation Stroke (POCS)

A

One of;

  • Cerebellar or brainstem syndromes
  • Loss of consciousness
  • Isolated Homonymous Hemianopia
32
Q

Describe the diagnostic criteria of a Lacunar Circulation Stroke (LACS)

A

One of;

  • Unilateral weakness and/or sensory deficit of Face,Arm,Leg or all
  • Ataxic hemiparesis
  • Pure sensory stroke

Clinical Neuroscience (19 decks)

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