Stroke - Presentation & Investigation Flashcards
What is a stroke?
3
Neurological deficit (‘loss of function’) of sudden onset, lasting more than 24 hours, of vascular origin.
What is a stroke also known as?
2
Transient ischaemic attack (TIA)
Cerebrovascular accident (CVA)
What are the symptoms of a stroke?
5
loss of power loss of sensation loss of speech (dysphasia) loss of vision loss of coordination
What is dysarthria?
slurred/slow speech
What is dysphasia?
loss of speech
What are the findings on taking a neurological history/examination of a stroke patient?
- loss of motor function
- loss of sensory function
- impaired speech
- loss of spatial awareness
- loss of vision
- ataxia
- vertigo
- nystagmia
Outline the two main types of stroke?
- haemorrhage
- thromboembolus/embolus
If a stroke patient has headache, vomiting, neck stiffness or photophobia what does this suggest?
haemorrhage
What is nystagmia?
condition in which the eyes make repetitive and uncontrolled movements, sign of stroke.
What is ataxia?
neurological sign consisting of lack of voluntary coordination of muscle movements, sign of stroke
What is gaze palsy?
an inability to move both eyes in a single direction
How would a haemorrhage appear on a head CT?
areas of white (haemorrhaged blood)
How would an ischaemic stroke appear on a head CT?
areas of dark (water), squashed midline
What is penumbra?
tissue that is alive but not perfused. It is at risk of infarction but can be saved if reperfused
What are the three circulations within the brain?
anterior circulation
posterior circulation
circle of Willis
The carotid system supplies most of the ______ and _______________.
hemispheres
cortical deep white matter
The vertebro-basilar system supplies the ___________, _________ and _____________.
brain stem
cerebellum
occipital lobes
What is the Broca’s area of the brain responsible for?
speech
What is the frontal lobe responsible for?
4
judgement
foresight
voluntary movement
smell
What is the motor cortex of the brain responsible for?
movement
What is the sensory cortex of the brain responsible for?
heat, pain and other sensations
What is the parietal lobe responsible for ?
comprehension of language
What is the temporal lobe responsible for?
2
hearing
intellectual and emotional functions
What is the occipital lobe responsible for?
vision
What is the Wernicke’s area of the brain responsible for?
speech comprehension
What is the cerebellum responsible for?
coordination
What is the brainstem responsible for?
5
swallowing breathing heart beat wakefullness centre other involuntary functions
If a stroke is small and affects deep white matter, what will the result be?
It will result in a major deficit as the fibres are packed close together.
Outline the causes of stroke.
4
- Blockage of a vessel with thrombus/clot
- Disease of vessel wall
- Disturbance of normal properties of blood
- Rupture of vessel wall
(haemorrhage)
What type are the majority of strokes?
ischaemic
What are the causes of ischaemic stroke, specifically?
- carotid stenosis
- cardioembolic
- small artery stroke
- rare causes: arterial dissection, CVST
- idiopathic
What is the name given to a stroke due to small vessel occlusion?
lacunar stroke
What is a cardioembolic stroke?
What is the main cause of them?
- when the heart pumps unwanted materials into the brain circulation, resulting in the occlusion of a brain blood vessel and damage to the brain tissue.
- atrial fibrillation
What causes carotid stenosis?
Where in the carotid does this occur?
atherosclerosis
at the bifurcation
What are two kinds of haemorrhagic stroke?
- primary intracerebral haemorrhage
- secondary haemorrhage (subarachnoid or atriovenous malformation)
What does the internal carotid artery supply?
brain
What does the external carotid artery supply?
face
What are the symptoms of stroke dependant of?
the artery or area of the brain affected
What are the different areas of the brain that stroke can affect?
(4)
- Left or right
- Carotid/vertebrobasilar territory
- Cerebral hemispheres or brainstem
- Cortex or deep white matter
What is the main problem caused by brain stem strokes?
inability to swallow
Why is it important to localise stroke?
4
- confirms the diagnosis of a stroke
- allows better selection of imaging
- gives an indication of cause
- gives an indication of prognosis
What is unilateral field loss?
loss of vision in one eye
What is bitemporal hemianopia?
loss of vision from one half of each, the loss is in the opposite halves
What is homonymous hemianopia?
loss of sight from one side in both eyes, the loss is from the same side in both eyes
Homonymous hemianopia with right sided vision defect is indicative of what?
left cerebrovascular accident/event
What is a total anterior circulation stroke (TACS) due to?
occlusion of proximal middle cerebral artery or internal carotid artery
What are the symptoms/signs of TACS?
3
- weakness/sensory deficit
- homonymous hemianopia (loss of vision)
- Higher cerebral dysfunction (e.g. dysphasia)
What is partial anterior circulation stroke (PACS) caused by?
occlusion of branches of middle cerebral artery (more restricted cortical infarcts)
What are the symptoms/signs of PACS?
2/3 of the TACS symptoms:
- weakness/sensory deficit
- homonymous hemianopia (loss of vision)
- Higher cerebral dysfunction (e.g. dysphasia)
What is occluded in a lacunar stroke (LACS)?
lacunar artery (smaller vessel)
What can the symptoms associated with LACS differ?
3
- pure motor
- pure sensory
- sensorimotor
What are the pure motor symptoms of LACS?
- Complete/incomplete weakness of one side.
- involving 2/3 body areas (face/arm/leg)
What are the pure sensory symptoms of LACS?
same distribution as motor, but sensory
Which areas does posterior circulation strokes (POCS) affect?
(3)
brainstem, cerebellar or occipital lobes.
What are the symptoms/signs of POCS?
8
- bilateral motor/sensory deficit
- disordered conjugate eye movement
- isolated homonymous hemianopia
- coma
- disordered breathing
- tinnitus
- vertigo
- Horner’s
Which classification of stroke has the best prognosis?
LACS
Which classification of stroke has the poorest prognosis?
TACS
Which classification of stroke has the highest recurrence rate?
PACS
What are the modifiable risk factors associated with stroke?
- high BP
- AF
What are the non-modifiable risk factors associated with stroke?
- age
- gender
- FH
