Stroke- Pathology and Clinical Assessment

Question 1

What is a stroke (4)

Answer 1

• Neurological deficit (loss of function)
• Sudden onset
• Lasting more than 24 hours
• Of vascular origin

Question 2

Symptoms: Loss of (5)

Answer 2

Power
Sensation
Speech
Vision
Coordination

Question 3

Neurological History/Examination (7)

Answer 3

• Motor- clumsy or weak limb
• Sensory- loss of feeling
• Speech- dysarthria/dysphasia
• Neglect/visuospatial problems
• Vision- loss in one eye, or hemianopia (blindness over half the field of vision)
• Gaze palsy (movement of eye in one direction)
• Ataxia (disorders that affect co-ordination, balance and speech)/vertigo/incoordination/nystagmus (involuntary eye movement)

Question 4

Pathophysiology of a stroke (3)

Answer 4

Damage to part of the brain
Blocked blood vessel by thrombus or embolus
Haemorrhage due to ruptured blood vessel

Question 5

4 lobes of the cerebral cortex

Answer 5

Parietal
Temporal
Occipital
Frontal

Question 6

What is the Frontal responsible for

Answer 6

Smell

Question 7

What is the occipital responsible for

Answer 7

Primary vision

Question 8

What is the temporal responsible for

Answer 8

Intellectual and emotional function

Question 9

Whats is the parietal responsible for

Answer 9

Comprehension of language

Question 10

An ischaemic stroke is when

Answer 10

a blood clot stops blood supply to the brain

Question 11

A heamorrhagic stroke

Answer 11

haemorrhage/blood leaks into brain tissue

Question 12

What are the causes of ischaemic stroke (5)

Answer 12

Large artery atherosclerosis
Cardioembolic
Small artery occlusion
Artery dissection
Venous sinus thrombosis

Question 13

Why is localisation of a stroke important (4)

Answer 13

Diagnosis
Imaging
Cause
Prognosis

Question 14

Causes of carotid stenosis (2)

Answer 14

Cardioembolic stroke (caused by atrial fibrillation)
Carotid dissection

Question 15

What are the 3 visual field defects

Answer 15

1. Unilateral field loss (L or R optic nerve compression)
2. Bitemporal hemianopia (Chiasmal compression from pituitary tumour)
3. Homonymous hemianopia (Left cerebrovascular event)

Question 16

What are the 4 stroke subtypes

Answer 16

TACS
PACS
LACS
POCS

Question 17

TACS

Answer 17

Total Anterior Circulation Stroke

Question 18

PACS

Answer 18

Partial Anterior Circulation Stroke

Question 19

LACS

Answer 19

Lacunar Stroke

Question 20

POCS

Answer 20

Posterior Circulation Stroke

Question 21

Features of TACS

Answer 21

	20% of strokes
	Weakness
	Sensory deficit
	Homonymous hemianopia
	Higher cerebral dysfunction (occlusion of proximal middle cerebral artery or internal carotid artery)

Question 22

Features of PACS

Answer 22

 Restricted motor/sensory deficit
 One limb, face and hand or higher cerebral dysfunction
 More restricted cortical infarcts- occlusion of branches of middle cerebral artery

Question 23

Features of LACS

Answer 23

 Pure motor (weakness of 1 side involving the whole of 2 or 3 body areas)
 Pure sensory
 Sensorimotor (combination of the above)

Question 24

Features pf POCS

Answer 24

 Affecting brainstem, cerebellar or occipital lobes
 Bilateral motor/sensory deficit
 Isolated homonymous hemianopia