Stroke – presentation and investigation **(eye thing to be re-explained) Flashcards
What is the definition of a stroke
Neurological deficit (‘loss of function’)of sudden onset, lasting more than 24 hours, of vascular origin
How long does a Transient Ischaemic Attack - precursor of a stroke
less that 24 hours
What is the symptoms of a stroke
Loss of power - motor weakness
Loss of sensation/feeling
Loss of speech
Loss of vision
Loss of coordination
What is the two different forms of loss of speech
Dysarthria - struggle to from the words
Dysphasia - struggle to find the words
What is the different loss of visions that can occur in a stroke
loss in one eye,
hemianopia - blindness over half the field of vision
Gaze palsy - symmetric limitation of the movements of both eyes in the same direction
What is the different forms of loss of coordination in a stroke
Ataxia - loss of all body movements
vertigo - sensation of loss of balance
incoordination - lack of coordination
nystagmus - rapid involuntary movements of the eye
What is the pathology of a stroke
damage to part of the brain due to a blockage of a blood vessel through thrombus or embolus or due to haemorrhage from a rupture blood vessel
What is the aetiologies of a stroke
85% infarction
15% haemorrhage
What is the anterior and posterior circulation joined by in the brain
circle of willis
What is the pathway of the anterior circulation in the brain
The internal carotid artery divides into the middle cerebral artery and the anterior cerebral artery which goes into the communicating artery
What is the pathway of the posterior circulation in the brain
The vertebral arteries join at the base of the brain to from the basilar artery then branch to from the superior cerebellar artery and posterior cerebral artery
What does the carotid system supply
most of the hemispheres - anterior and middle cerebral and cortical deep white matter
What does the vetero-bassilar system supply
supplies the posterior cerebral, the brain stem, cerebellum and occipital lobes
What is the problem of a small stroke occurring in an area of fibres being packed closely together
Causes major deficit
What does the symptoms of a stroke depend
Which part of the brain is affected
What is the different aetiologies of an ischaemic stroke
Large artery athlersclerosis
cardioembolic stroke
Lucunar stroke
Rarer causes
What artery goes through athersclerosis resulting in a stroke
stenosis of the carotid
What causes cardioembolic stroke
atrial fibrillation -irregular heartbeat that can lead to blood clots
What causes lacunar stroke - small artery occlusion
Normally due to hypertension, thickening wall meaning narrowing arteries
What can the occlusion of many small arteries result in
Major defecit
What is examples of rare cases of ischaemic strokes
Carotid arterial dissection (spontaneous or traumatic)
Venous sinus thrombosis
Where does primary haemorrhage occur
intraceterbral
where does secondary haemorrhage occur
subarchnoid or ateriovenous malformation
What is the possible aetiologies of a ruptured blood vessel
Hypertension aneurism
What needs to be differentiated to localise the area of the stroke
Left or right
Carrotid or verterobasilar territory
Cerebral hemispheres or brainstem
cortex or deep white matter
The signs and symptoms on examination provide you with what information
What side of the brain is affected
whether lesion is in the brainstem, cortex, white matter
and what blood vessel is involved
If leison is found in the white matter what kind of stroke is it
Lacunar stroke
What is the use in localising stroke
Confirm the diagnosis
Allow better selection of imaging
give indications of cause
give an indication of the prognosis
What is the 4 subtypes of strokes
Total anterior circulation
Partial anterior circulation stroke
Lacunar stroke
Posterior circulation stroke
What is the symptoms of TACS
weakness, sensory deficit Homonymous hemianopia (loss of vision) Higher cerebral dysfunction (eg dysphasia, dyspraxia)
What is TACS due to
occlusion of proximal Middle cerebral artery + internal carotid artery
What is the symptoms of PACS
2 of 3 weakness, sensory deficit Homonymous hemianopia (loss of vision) Higher cerebral dysfunction (eg dysphasia, dyspraxia
e.g. just one limb, face, and cerebral dysfunction
What is PACS due to - what does this mean
occlusion of branches of middle cerebral artery - smaller stroke
Where does a lacunar stroke occur
Internal capsule - where motor and sensory fibres are coming down
What is the symptoms of Lacunar stroke
Weakness of one side, involving 2 of the 3 body areas (face, arm, leg), and loss of sensory everywhere
How can a lunar stroke go silent and un-diagnosed
As there is no problems with their speech, awareness or their co-ordination
A bigger lacunar stroke will dow what
affect sensory and motor
What does POCs affect
Brain stem
cerebellum
occipital lobes
What is the presentations of a POCS stroke
motor/sensory deficit - Disordered eye movement/Hemianopia -Coma -Disordered breathing -Tinnitus - ringing in the ear -Vertigo - loss of balance Horner’s - sympathetic trunk damage
What is the investigations for a stroke
Full blood test
ECG
CT scan
MRI - differentiates between haemorrhage and ischaemic
ECHO
