Stroke (Ischemic)

Question 1

Transient Ischemic Attack is a temporary focal loss of neurological function last less than

Answer 1

24 hours

Question 2

Carotid arteries involvement

Answer 2

Transient loss of vision on one eye

Hemiparesis

Inability to speak

Question 3

Vertebrobasilar arteries involvement

Answer 3

Tinnitus

Vertigo and blurring vision

Hemiparesis

Question 4

Definition of Ischemia

Answer 4

a reduction in blood flow that can last for several seconds to a
few minutes

Question 5

Infarction

Answer 5

If there is cessation of flow for than a few minutes, infarction of
brain tissue occurs

Question 6

Pathophysiology in Ischemic Stroke

Answer 6

 Reduce blood flow in the arteries can be thrombosis or embolism

 Reduction in blood flow deprives the cells of O2 and glucose

 Lack of energy causes membrane dysfunction and entry of ions

 Edema of cells occurs, followed by death of cells

 Vascular changes aggravate edema

Question 7

Causes of thrombosis

Answer 7

Arterial disease
 Atherosclerosis, arteritis

Blood disorders
 Thrombocytosis, polycythemia

Question 8

Definition of Embolism

Answer 8

Thrombosis occurs in other parts of the body

A part of the thrombus detaches and travel to the brain through the
arteries

Question 9

Causes of embolism

Answer 9

Embolic strokes are usually caused by a blood clot that forms elsewhere
in the body (embolus) and travels through the bloodstream to the brain.

Embolic strokes often result from heart disease or heart surgery and
occur rapidly and without any warning signs.

About 15% of embolic
strokes occur in people with atrial fibrillation, a type of abnormal heart
rhythm in which the upper chambers of the heart do not beat effectively

Question 10

Clinical presentation of Ischemic stroke

Answer 10

Transient Ischemic Attacks (TIA)

Any neurological dysfunction that lasts for a few seconds to a
few minutes

Should recover within 24 hours

 Pathogenesis of TIA

 Low-flow states in vascular obstruction

 Small emboli which get dissolved later

 Recognition of TIA helps in prevention of major stroke

Question 11

Established stroke

Answer 11

Infarction of brain tissue occurs due lack of blood. Deficit is permanent

 Increasing obstruction may involve a proximal branch of the artery and increase the deficit: stroke-in-evolution

 Edema occurs in surrounding tissue

 Resolution of edema after the acute stage may restore some
function

Question 12

Clinical presentation of Ischemic stroke (site)

Answer 12

Depend on the site of obstruction

 the artery or its branch involved
 the brain area supplied by the artery

Depend on the state of circulation

 Presence of good arteries in the adjacent area may provide collateral
circulation
 Also on the state of general circulation

Onset
 Embolism - sudden, during exertion
 Thrombosis - slow, during rest time

Question 13

Anterior Cerebral Artery

Involvement of Superficial branches signs and symptoms

Answer 13

Prefrontal lobe: confusion, disorientation

 Medial surface: paralysis and sensory loss in the opposite leg

 Apraxia, abulia and urinary incontinence in bilateral lesions

Question 14

Anterior Cerebral Artery

Involvement of Deep Branches

Answer 14

Obstruction is well tolerated because of collateral flow

Question 15

Middle Cerebral Artery

 Involvement Deep branches

Answer 15

Corticospinal fibers in internal
capsule - paralysis of opposite side

Question 16

Middle Cerebral Artery

Involvement of Superficial
branches

Superior division:

Answer 16

Superior division: paralysis of face
and hand, conjugate gaze paralysis,
motor aphasia

Question 17

Middle Cerebral Artery

Involvement of Superficial
branches

Inferior division:

Answer 17

Inferior division: conduction or
sensory aphasia, construction or
dressing apraxia

Question 18

Vertebro-basilar territory

 Presence of cerebellar symptoms

What are the cerebellar sx?

Presence of brain lesion

What are the brain lesion sx?

Answer 18

Presence of cerebellar symptoms
 Ataxia, Intention tremor, In-coordination

Presence of brain lesion
 Crossed paralysis and sensory loss

Question 19

Posterior cerebral artery

Superficial branches

Deep branches

Answer 19

Visual loss, memory loss, agraphia

Thalamic syndromes

Question 20

Ipsilateral lesion

Answer 20

Cerebellar ataxia

 Wide-based, staggering unsteady gait

 Vermis lesions produce truncal ataxia

Intention tremor

 Incoordination of arm and leg on voluntary movement

 Worse when approaching target, diminishes with rest

 Finger-nose test, heel-shin test

Dysmetria

 Error in judging distance resulting in overshooting

 May be accompanied by tremor

Rebound phenomenon

 Difficulty in stopping the movement when resistance is withdrawn suddenly

Question 21

Dysdiadochokinesia

Answer 21

Inability to perform rapid alternating opposite movements

Pronation-supination, ankle flexion-extension

Question 22

Decomposition of movements

Answer 22

Inability to perform actions that involve more than one joint
simultaneously

Movement are broken into many components, one joint at a
time

Robotic movement

Question 23

Nystagmus

Answer 23

due to incoordination of extraocular muscles

Question 24

Scanning speech

Answer 24

Words are broken into many component sounds

‘Staccato’ speech

Question 25

Hypotonia

Answer 25

Decreased muscle tone and tendon reflexes

Question 26

Asthenia

Answer 26

Muscles affected are weaker and tire more easily than normal muscles

Question 27

Treatment for Ischemic stroke

Answer 27

Clot busters

IV tissue Plasminogen
Activator (tPA)

Question 28

Preventive Treatment for Ischemic stroke

Answer 28

Anticoagulants/Antiplatelets

 Antiplatelet: aspirin

 Anticoagulants: warfarin

 Carotid Endarterectomy
-Surgically remove plaque

Angioplasty/Stents
- Use balloon angioplasty
- Implant stents reduce fatty buildup

Question 29

Warfarin Counseling

Answer 29

blood thinner

 Prevent formational of blood clots

 Treatment duration varies

 Modification diet: Be consistent, avoid sudden reduction
of Vit K in diet

 Need monitor INR and make sure within therapeutic
range 2-3

 Monitor for side effects

 Special precautions