Stroke Syndromes

Question 1

Define stroke

Answer 1

An acute neurological deficit caused by a cerebrovascular aetiology

Question 2

Define ischaemic stroke

Answer 2

An acute neurological deficit caused by a lack of blood perfusion due to occlusion or critical stenosis of a cerebrospinal artery

Question 3

Define haemorrhagic stroke

Answer 3

An acute neurological deficit caused by a lack of blood perfusion due to rupture of a cerebrospinal artery

Question 4

Describe the difference between primary and secondary haemorrhagic stroke

Answer 4

Primary: haemorrhage in the absence of vascular malformation or associated disease
Secondary: haemorrhage from an identifiable vascular malformation or from a disease impairing coagulation or promoting vascular rupture

Question 5

State some causes of ischaemic stroke

Answer 5

Cardioembolism, atherosclerosis, small vessel disease (lacunar stroke), cerebral venous sinus thrombosis, vasculitis, sickle cell anaemia, antiphospholipid syndrome

Question 6

State some causes of haemorrhagic stroke

Answer 6

Aneurysms, arteriovenous malformations, primary intracerebral haemorrhage, subarachnoid haemorrhage, acute ischaemic stroke, subdural haemorrhage, cavernoma

Question 7

Which type of strokes does cerebral amyloid angiopathy predispose to?

Answer 7

Primary haemorrhagic lobar strokes

Question 8

Name 2 drugs which can cause secondary haemorrhagic stroke

Answer 8

Cocaine, amphetamines

Question 9

State some risk factors for ischaemic stroke

Answer 9

Ageing, family or personal history, hypertension, smoking, diabetes, dyslipidaemia, AF, past MI, carotid artery stenosis, valve disease, sickle cell anaemia

Question 10

State some risk factors for haemorrhagic stroke

Answer 10

Ageing, male sez, family history, haemophilia, cerebral amyloid angiopathy, hypertension, anticoagulation, cocaine or amphetamine use, vascular malformations

Question 11

Which type of stroke is more common in women?

Answer 11

Subarachnoid haemorrhage

Question 12

State the most common cause of non-traumatic subarachnoid haemorrhage

Answer 12

Rupture of intracranial saccular aneurysm

Question 13

State the 3 most common aneurysm sites in the CNS arteries

Answer 13

Anterior communicating artery and anterior cerebral artery junction, distal internal carotid artery and posterior communicating artery junction, middle cerebral artery bifurcation

Question 14

State some risk factors for subarachnoid haemorrhage

Answer 14

Hypertension, smoking, family history, autosomal dominant polycystic kidney disease, alcohol use, cocaine use, connective tissue disorders

Question 15

Describe the typical presentation of an ophthalmic artery stroke

Answer 15

Uniocular loss of vision, transient amaurosis fugax

Question 16

Describe the typical presentation of an anterior cerebral artery stroke

Answer 16

Leg and trunk weakness, excessive or inappropriate crying or laughing
If bilateral: gait apraxia

Question 17

Describe the typical presentation of a middle cerebral artery stroke

Answer 17

Contralateral hemiparesis, eye deviation towards infarct, contralateral hemianaporia, contralateral hemianaesthesia, global aphasia, visual neglect

Question 18

Describe the typical presentation of a posterior cerebral artery stroke with parieto-occipital involvement

Answer 18

Unilateral homonymous hemianopia, Anton syndrome, Balint syndrome

Question 19

Describe the typical presentation of a posterior cerebral artery stroke with thalamic involvement

Answer 19

Confusion, memory loss, pure hemisensory loss

Question 20

Describe the typical presentation of a brainstem infarct

Answer 20

Vertigo, nystagmus, diplopia, dysarthria, dysphagia, limb or trunk ataxia, contralateral pain and temperature loss, cranial nerve V-XII involvement

Question 21

State the 3 components of Virchow’s triad

Answer 21

Stasis, vessel wall injury, hypercoagulability

Question 22

State some specific causes of venous thrombosis

Answer 22

Surgery, obesity, long-haul flights, reduced circulating blood volume, right-sided heart failure

Question 23

Name 3 causes of cardiac mural thrombus

Answer 23

Atrial fibrillation, cardiomyopathy, previous myocardial infarction

Question 24

Where do strokes appear to most commonly occur?

Answer 24

Deep in the white matter of the internal capsule and basal ganglia in the left hemisphere

Question 25

Which hemisphere is more prone to ‘silent’ strokes?

Answer 25

Right

Question 26

Why are end arteries most vulnerable to blockage?

Answer 26

They have no collateral arteries to take over blood supply

Question 27

Describe the typical presentation of a posterior inferior cerebellar artery infarct

Answer 27

Ataxia, Horner’s syndrome, cranial nerve palsies

Question 28

What is Horner’s syndrome?

Answer 28

Triad of ptosis, miosis, and anhidrosis

Question 29

State some causes of lacunar infarcts

Answer 29

Hypertension, ageing, diabetes mellitus, renal disease, migraine, CADASIL

Question 30

State at least 5 features of the acute phase of ischaemic stroke

Answer 30

Decreased blood flow, disturbed ionic homeostasis, increased intracellular calcium, increased glutamate release, cytotoxic oedema, mitochondrial and DNA damage, enzyme dysfunction, necrosis

Question 31

State at least 5 features of the subacute phase of ischaemic stroke

Answer 31

Apoptosis, inflammation, cytokine production, proteolytic enzyme activation, vasogenic oedema and raised ICP, ROS production, stimulation of neurogenesis and angiogenesis

Question 32

State at least 5 features of the chronic phase of ischaemic stroke

Answer 32

Removal of necrotic debris, stem cell proliferation and differentiation, angiogenesis, gliosis, circuit reconnection, neurovascular remodelling