Stroke: Ischaemic Stroke Flashcards
Definition
Rapid onset of neurological deficit
- lasting for more than 24 hours
- poor blood flow to brain causes cell death
Epidemiology
Older people
Males
Risk factors
Hypertension: the single greatest risk factor
Age: the average age for a stroke is 68 to 75 years old
Smoking
Diabetes
Hypercholesterolaemia
Atrial fibrillation
Family history
Haematological disease: such as polycythaemia
Medication: such as hormone replacement therapy or the combined oral contraceptive pill
Aetiology
Reduction in cerebral blood flow due to arterial occlusion or stenosis.
- Cardiac:
=Atherosclerotic disease: smoking, hypertension , diabetes , high cholesterol
= Atrial fibrillation
= Paradoxical embolism due to septal abnormality, such as a patent foramen ovale
- Vascular
= Aortic dissection
=Vertebral dissection
= Vasculitides
- Haematological
= Hypercoagulability, such as antiphospholipid syndrome
= Sickle cell disease
= Polycythaemia
Pathophysiology
Reduction in cerebral blood flow due to arterial occlusion or stenosis. Typically divided into thrombotic, embolic and lacunar.
Blood vessel to/in brain occluded by a clot
Ischaemia + infarction follow
- Infarcted areas dies, resulting in focal neurological symptoms
- Infarcted area is surrounded by a swollen area (oedema) which can regain function with neurological recovery
ACA Signs
If ACA:
- Contralateral Hemiparesis + sensory loss (lower limbs more than upper limbs)
- Akinetic Mutism (will not speak or move, no motivation to do so)
MCA Signs
- Contralateral hemiparesis and sensory loss with upper limbs > lower limbs
- Contralateral Homonymous hemianopia
- DOMINANT SIDE = APHASIA:
Wernicke’s Aphasia (aka receptive aphasia) = cannot understand speech (posterior superior temporal lobe)
Broca’s Aphasia (aka Expressive Aphasia) = cannot produce speech (left inferior frontal gyrus) - NON DOMINANT = APRAXIA AND HEMINEGLECT SYNDROME
Apraxia = patient can move muscles to do stuff, but don’t know how to
Hemineglect syndrome = all visual and sensory sensations on the contralateral side is neglected
E.g. if the left MCA is affected, the left optic radiations will be affected so the right visual field will be lost = right homonymous hemianopia.
PCA signs
Visual problems
- Homonymous hemianopia with macula sparring (as the MCA can still supply the region of the occipital lobe which is responsible for the macular)
- Visual agnosia (patient can see but not interpret symbols e.g. letters)
Vertebrobasilar
Cerebellar signs
Reduced consciousness
Quadriplegia (paralysis of all 4 limbs - arms and legs) or hemiplegia
Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)
- Ipsilateral CN III palsy
- Contralateral weakness of upper and lower extremity
Anterior inferior cerebellar artery (lateral pontine syndrome)
- Symptoms are similar to Wallenberg’s but:
- Ipsilateral: facial paralysis and deafness
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
- Ipsilateral: facial pain and temperature loss
- Contralateral: limb/torso pain and temperature loss
- Ataxia, nystagmus
Retinal/ophthalmic artery
Amaurosis fugax
Basilar artery
Locked in syndrome
Lacunar stroke
Affects the small perforating branches to subcortical structures (e.g. internal capsule, basal ganglia, thalamus, pons)
- Present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
- Strong association with HTN