Stroke I

Question 1

What is the definition of a stroke?

Answer 1

fixed neuro deficit of sudden onset, usually due to pathology in blood vessels.

Question 2

What is a thrombotic stroke?

Answer 2

stroke caused by thrombosis of large intracranial vessels, usually at points of bifurcation.

Question 3

What is typical onset of thrombotic stroke?

Answer 3

stuttering onset, often while the pt is asleep

Question 4

Characteristics of middle cerebral artery thrombotic stroke?

Answer 4

arm and leg of contralateral side equally effected if infarct involves the internal capsule. visual field cut and higher cortical deficits like aphasia, apraxia, agnosia are also seen

Question 5

characteristics of vertebro-basilar stroke

Answer 5

brain stem findins: opthalmoplegia, pupillary abnormalities, facial weakness and numbness, difficulty with speech and swallowing, long tract signs, vertigo, ataxia, syncope

Question 6

What is lateral medullary syndrome?

Answer 6

infarction of the vertebbral artery. nausea, vomiting, cardiac arrhythmias, ipsilateral facial numbness and and contralateral body numbness, ipsilateral ataxia, hoarseness, dysphagia, ipsilateral Horner’s syndrome (sympathetic defects)

Question 7

What is an embolic stroke?

Answer 7

stroke due to the occlusion of small, distal cortical vessels from an embolus.

Question 8

What is the onset of an embolic stroke?

Answer 8

usually of abrupt onset and occur during the day. deficit maximal at the start with gradual resolution

Question 9

What are the sources of emboli for embolic strokes?

Answer 9

atherosclerotic plaques of ascending aorta, internal carotids, and vertebro-basilar system
cardiac sources: usually in the setting of recent myocardial infarction with mural thrombosis, afib, low output state, or valvular heart disease, or paradoxical emboli from right heard due to ASD or patent foramen ovale

Question 10

What is a hemorrhagic stroke?

Answer 10

stroke due to cerebral hemorrhage of sudden onset

Question 11

What are the 4 types of hemorrhagic stroke?

Answer 11

hypertensive intracerebral hemorrhage
arterio venous malformation
ruptured aneurysm
amyloid angiopathy

Question 12

What is hypertensive intracerebral hemorrhage? What are the most common sites?

Answer 12

rupture of small, penetrating blood vessels from chronic hypertension.
pons, cerebellum, thalamus, and putamen

Question 13

What is amyloid angiopathy?

Answer 13

cause of lobar hemorrhage in elderly patients, esp. those with a history of hypertension. amyloid protein is deposited in the walls of thecerebral blood vessels and weakens them –> more prone to spontaneous hemorrhage. this proteins is the same as the amyloid in brains of Alzheimer’s patients

Question 14

What is a lacunar stroke?

Answer 14

due to infarction of small, deep, penetrating blood vessels, usually in setting of chronic hypertension or DM

Question 15

4 clinical lacunar stroke syndromes

Answer 15

pure motor: internal capsule or pons stroke
pure sensory: thalamus
clumsy hand-dysarthria: internal capsule/pons
leg paresis-ataxia: internal capsule/pons

Question 16

What happens with surrounding edema in stroke pts? (when is it seen, what type of stroke, what are symptoms)

Answer 16

prominent 72-96 hrs poste event; usually in large, thrombotic occlusions. patient is usually lethargic

Question 17

What is cerebral herniation?

Answer 17

seen with massive thrombotic occlusion with resultant cerebral edema: cerebellar infarcts with edema may compress the pons and kill patient

Question 18

What is stroke in evolution?

Answer 18

due to progressive occlusion of a large vessel from ongoing atherosclerosis. worsening neuro deficits in the SAME vascular distribution

Question 19

What is locked-in syndrome?

Answer 19

stroke syndrome of preserved consiousness and sensation with absent motor output (maybe eye blinking and vertical eye movements ok) due to infarction of branches of the basilar artery supplying the ventral portions of the brain stem

Question 20

What happens with seizure and strokes? WhAt is the time course?

Answer 20

early complication of embolic strokes, since they often lodge in the periphery
late (9 mo. or more) complication of thrombotic strokes,esp. seen in eldery with metabolic derangements

Question 21

What is hemorrhagic transformation?

Answer 21

usually of embolic strokes and sometimes of large throbitic infarcts within 24 hrs of stroke onset. aanticoagulation and severe hypertension may incr. incidence. may also occur with tumors

Question 22

What presents as stuttering onset?

Answer 22

thrombotic/lacunar

Question 23

What are the types of aneurysms?

Answer 23

saccular (aka “berry”), mycotic (infectious endocarditis), fusiform/dolichoectasia: elongation and dilation from atherosclerosis