Stroke (Categories)

Question 1

What is the hallmark of stroke?

Answer 1

Sudden and rapid onset of neurological dysfunction

Question 2

How many Oxford categories can strokes be divided into? What is the purpose of these categories?

Answer 2

4 - categories correlate the clinical features arising from dysfunction in specific areas of the brain

Question 3

What is anterior circulation syndrome? What categories is this sub-divided into?

Answer 3

Strokes affecting brain regions supplied by the internal carotid arteries and their major terminal branches, the anterior and middle cerebral arteries. Sub-divided into total anterior circulation syndrome and partial anterior circulation syndrome.

Question 4

What features must be present to have total anterior circulation syndrome?

Answer 4

Contralateral hemiplegia or hemisensory loss involving at least two of the face, arm or leg, contralateral homonymous hemianopia and cortical signs e.g. dysphagia, neglect

Question 5

Which Oxford classification is the most severe type of stroke?

Answer 5

TACS

Question 6

Signs of higher cortical dysfunction vary depending on what?

Answer 6

Whether the dominant or non-dominant side of the brain is affected

Question 7

What features must be present to have partial anterior circulation syndrome?

Answer 7

2/3 features present in TACS (motor/sensory deficit, homonymous hemianopia, higher cortical dysfunction)

Question 8

Which vessels are affected in lacunar syndrome?

Answer 8

Deep penetrating arteries from either the anterior or posterior circulations

Question 9

Lacunar infarcts are most likely to affect which brain structures?

Answer 9

Deep structures e.g. basal ganglia, thalamus, internal capsule and also the brainstem

Question 10

Which features must be present to have lacunar syndrome?

Answer 10

One of pure motor deficit, pure sensory deficit (affecting 2 of face, arm, leg) or an ataxic hemiparesis

Question 11

Which features are never present in lacunar syndrome?

Answer 11

Higher cortical dysfunction of any symptoms of posterior circulation syndrome

Question 12

Which Oxford classification of stroke has the best prognosis?

Answer 12

Lacunar syndrome

Question 13

What brain regions are affected in posterior circulation syndrome?

Answer 13

Those supplied by the vertebrobasilar vessels and their branches (posterior cerebral, posterior inferior cerebellar and superior cerebellar arteries)

Question 14

What are some of the symptoms that posterior circulation syndrome can cause?

Answer 14

Cranial nerve palsies, bilateral motor/sensory deficits, isolated homonymous hemianopia, cerebellar deficits, brainstem signs and symptoms

Question 15

What are some examples of symptoms/signs that cranial nerve palsies caused by POCS might cause?

Answer 15

Diplopia, facial sensory loss, LMN facial nerve palsy, vertigo, hearing loss, dysphagia, dysarthria

Question 16

What are some examples of cerebellar symptoms/signs that may be seen in POCS?

Answer 16

Ataxia, nystagmus, intention tremor, dysarthria, slurred speech

Question 17

The clinical pattern of what in certain types of strokes can indicate whether the dominant or non-dominant side of the brain is affected?

Answer 17

Higher cortical dysfunction

Question 18

What is the relationship between a stroke affecting the dominant/non-dominant side of the brain and insight?

Answer 18

If the stroke affects the dominant hemisphere the patients will usually have insight; if the non-dominant hemisphere is affected then patients will not have insight

Question 19

What are some higher cortical signs which may be seen when the dominant hemisphere is affected by a stroke?

Answer 19

Mainly affecting language (spoken and written) and also reasoning and number skills

Question 20

What are some higher cortical signs which may be seen when the non-dominant hemisphere is affected by a stroke?

Answer 20

Often affects spatial awareness and can cause neglect, disorientation and apraxias. Also affects creativity, music and artistic awareness

Question 21

What are the 3 important things to include when describing a stroke?

Answer 21

Cause of stroke, laterality and the category

Question 22

The Oxford classification of stroke only localises a lesion to a broad vascular territory. What are the more specific symptoms of the affected vessel being the anterior cerebral artery?

Answer 22

Contralateral lower limb motor and sensory deficit, urinary sphincter disturbance (incontinence), behavioural changes/dysinhibition

Question 23

The Oxford classification of stroke only localises a lesion to a broad vascular territory. What are the more specific symptoms of the affected vessel being the middle cerebral artery?

Answer 23

Contralateral motor deficit mainly affecting the face/upper limb, contralateral sensory deficit, higher cortical dysfunction, contralateral hemianopia

Question 24

A stroke affecting the PCA which supplies the occipital lobe will cause which sign?

Answer 24

Contralateral homonymous hemianopia

Question 25

A stroke affecting the PCA which supplies the temporal lobe will cause which symptom?

Answer 25

Memory disturbance

Question 26

A stroke affecting the PCA which supplies the thalamus will cause which symptoms?

Answer 26

Chorea/hemiballismus movements with contralateral hemisensory loss

Question 27

A stroke affecting the PCA which supplies the midbrain will cause which symptoms?

Answer 27

Gaze palsies, pupillary abnormalities and decreased conscious level