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CVS > Stroke Presentation and Investigation > Flashcards

Stroke Presentation and Investigation Flashcards

1
Q

What are the symptoms of a stroke?

A

Loss of:

  • Power
  • Sensation
  • Speech – comprehension/ability
  • Vision
  • Coordination
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2
Q

What are the essential things to ask about when taking a history?

A
  • Time of onset
  • Witnesses
  • Headache, vomiting, neck stiffness, photophobia
  • Loss of consciousness
  • Fit
  • Incontinence
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3
Q

What is the neurological history likely to be?

A

Motor (clumbsy or weak limb)

Sensory (loss of feeling)

Speech (dysarthia - unclear articulation of speech that is otherwise linguistically normal) Dysphasia (deficiency in the generation of speech, and sometimes also in its comprehension)

Neglect / visuospatial problems

Vision: Loss in one eye or hemianopia (blindness over half the field of vision). Gaze palsy (symmetric limitation of the movements of both eyes in the same direction)

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4
Q

What are the 2 types of stroke?

A

Infarction 85% - Damage to part of brain due to blockage of blood vessel by thrombus or embolus

Haemorrhage 15% - Rupture of blood vessel

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5
Q

What are the causes of stroke?

A

Blockage of vessel with thrombus or clot

Disease of vessel wall

Disturbance of normal properties of blood

Rupture of vessel wall (haemorrhage)

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6
Q

Look at the different arteries

A
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7
Q

What part of the brain does the carotid system supply?

A

Most of the hemispheres

Cortical deep white matter

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8
Q

What does the vertebro-basilar system supply?

A

Brainstem

Cerebellum and occipital lobes

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9
Q

What is the motor cortex responsible for?

A

Movement

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10
Q

What is the frontal lobe responsible for?

A

Judgement

foresight

voluntary movement

Smell

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11
Q

What is Broca’s arch responsible for?

A

Speech

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12
Q

What is the temporal lobe responsible for?

A

Intellectual and emotional functions

Hearing

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13
Q

What is the brainstem responsible for?

A

Swallowing, breathing, heartbeat, wakefulness centre and other involuntray functions

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14
Q

What is the cerebellum responsible for?

A

coordination

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15
Q

What is Wernicke’s area responsible for?

A

Speech comprehension

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16
Q

What is the occipital responsible for?

A

Primary visual area

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17
Q

What is the parietal lobe responsible for?

A

Comprehension of language

18
Q

What is the sensory cortex responsible for?

A

Pain heat and other sensations

19
Q

Summary

A
20
Q

What are the causes of ischaemic stroke?

A
  1. Large artery atherosclerosis (e.g. Carotid) 35%
  2. Cardioembolic (e.g. atrial fibrillation) 25%
  3. Small artery occlusion (Lacunar) 25%
  4. Undetermined/Cryptogenic 10-15%
  5. Rare causes <5%

—- arterial dissection

— - venous sinus thrombosis

21
Q

What are the causes of haemorrhagic stroke?

A
  1. Primary intracerebral haemorrhage 70%
  2. Secondary haemorrhage 30%

—Subarachnoid haemorrhage

—Arteriovenous malformation

22
Q

What is the danger of PCI in a carotid stenosis?

A

PCI can dislodge clot and cause a stroke

23
Q

What is the most common cause of cardioembolic stroke?

A

Atrial fibrillation - blood that isn’t flowing will clot

24
Q

What vessels does a lacunar stroke involve?

A
25
Q

What are the parts of the brain that can be affected by a stroke?

A

Left or right

Carotid territory or vertibrobasilar territory

Cerebral hemispheres or brainstem

Cortex or deep white matter

26
Q

What do symptoms tell you about the likely diagnosis of the type of stroke?

A

What side of brain affected

If Lesion in brainstem

If cortex involved

Is lesion in deep white matter

What blood vessels involved

27
Q

Why do we localise the origin of the stroke?

A

Confirms the diagnosis of the stroke

Allows better selection of imaging

Gives an indication of the cause

Gives an indication of the prognosis

28
Q

What are the stroke subtypes?

A

TACS: Total anterior circulation stroke

PACS: Partial anterior circulation stroke

LACS: Lacunar stroke

POCS: Posterior circulation stroke

29
Q

Describe the lesion and what would cause this defect?

A

Unilateral field loss

Left optic nerve compression

30
Q

What is the name of the following visual defect and the example lesion

A

Bilateral hemianopia - chiasmal compression from pituitary tumour

31
Q

What is the visual defect associated and give an example lesion

A

Homonmous hemianopia - left cerebrovascular event.

32
Q

What are the symptoms of total anterior circulation strokes (make up 20% of strokes in the community)?

A

Weakness, sensory deficit

Homonymous hemianopia (loss of vision)

Higher cerebral dysfunction (eg dysphasia, dyspraxia)

33
Q

What is TACS usually due to?

A

Occlusion of proximal MCA or ICA (Middle carotid artery or internal carotid artery)

34
Q

What are the features of PAC strokes? (35% of strokes)

A

2/3 of TACS criteria or restricted motor/sensory deficit

eg. one limb, face and hand or higher cerebral dysfunction alone

35
Q

What causes PACS?

A

Occlusion of branches of MCA - more restricted cortical infarcts

36
Q

What are the features of a lacunar stroke?

Pure motor

Pure sensory

Sensorimotor

Ataxic hemiparesis

A 
_Pure motor (commonest)_
Complete or incomplete weakness of 1 side, involving the whole of 2 of 3 body areas (face/arm/leg)

Pure sensory
Sensory symptoms and/or signs, same distribution

Sensorimotor
Combination of the above

Ataxic hemiparesis
Hemiparesis and ipsilateral cerebellar ataxia
Small infarcts in basal ganglia or pons.

37
Q

What is the cause of Lacunar strokes? (20% of strokes)

A

Intrinsic disease of single basal perforating artery (end arteries).

38
Q

What part of the brain does the posterior circulation stroke affect?

A

25% of stroke

Affecting brainstem, cerebellar or occipital lobes.

39
Q

What are the features of a POCS?

A

Bilateral motor/sensory deficit

disordered conjugate eye movement

isolated homonymous hemianopia

ipsilateral cranial nerve palsy with contralateral motor/sensory deficit

coma

disordered breathing

tinnitus

vertigo

Horner’sVariable, frequently complex presentation (may include any of the above)

40
Q

Summary of the Stroke epidaemiolgy

A

TACS - 20 %

PACS - 35%

POCS - 25%

LACS - 20%

CVS (26 decks)

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