Stroke/ TIA Flashcards
Define and differentiate the following terms:
1. Stroke
2. TIA
What percent of stroke survivors have another stroke/ TIA.
20%
What is the prevalence of stroke in 1. women, 2. men in the general population?
- 1/5 F
- 1/6 M
A stroke can be ischemic or hemorrhagic. What are the RFs for an ischemic stroke?
A stroke can be ischemic or hemorrhagic. What are the RFs for a hemorrhagic stroke?
A stroke can be ischemic or hemorrhagic. Describe the pathophysiology and causes of an ischemic stroke.
A stroke can be ischemic or hemorrhagic. List the causes of a hemorrhagic stroke.
Describe the anatomy of the circle of willis and parts of the brain that the branches supply?
Components of the Circle of Willis
The Circle of Willis is formed by anterior and posterior circulations and consists of:
Anterior Circulation: Supplied by the internal carotid arteries.
Posterior Circulation: Supplied by the vertebral arteries via the basilar artery.
Key Arteries:
Internal Carotid Arteries:
Contribute to the anterior and middle cerebral arteries.
Supply the anterior circulation of the brain.
Anterior Cerebral Arteries (ACAs):
Arise from the internal carotid arteries.
Extend medially to supply the medial surface of the frontal and parietal lobes.
Anterior Communicating Artery (AComm):
A single artery connecting the two anterior cerebral arteries.
Completes the anterior part of the circle.
Posterior Cerebral Arteries (PCAs):
Terminal branches of the basilar artery.
Supply the occipital lobe, inferior temporal lobe, and portions of the brainstem and thalamus.
Posterior Communicating Arteries (PComm):
Connect the posterior cerebral arteries to the internal carotid arteries.
Allow communication between anterior and posterior circulations.
Basilar Artery:
Formed by the fusion of the two vertebral arteries.
Supplies the brainstem, cerebellum, and posterior inferior cerebral arteries.
Vertebral Arteries:
Arise from the subclavian arteries and ascend through the transverse foramina of the cervical vertebrae.
Converge to form the basilar artery.
According to the oxford bamford classification for stroke, how would you classify a TACS. Include the most likely affected arteries.
According to the oxford bamford classification for stroke, how would you classify a PACS. Include the most likely affected arteries.
According to the oxford bamford classification for stroke, how would you classify a LACS. Include the most likely affected arteries.
According to the oxford bamford classification for stroke, how would you classify a POCS in general. Include the most likely affected arteries.
According to the oxford bamford classification for stroke, how would you classify medial medullary syndrome?
GPT -
Symptoms of Medial Medullary Syndrome (Classic Triad):
Contralateral hemiparesis (weakness of the arm and leg)
Due to involvement of the corticospinal tract before it decussates in the medulla.
The face is spared because the corticobulbar tract is not involved.
Ipsilateral hypoglossal nerve palsy (tongue deviation towards the lesion side)
Due to damage to the hypoglossal nucleus or nerve (CN XII) in the medulla.
When the patient sticks out their tongue, it deviates toward the side of the lesion.
Contralateral loss of proprioception and vibration sense
Due to involvement of the medial lemniscus, which carries information from the dorsal column (gracile and cuneate nuclei).
Pain and temperature sensation are preserved because the spinothalamic tract is not affected.
According to the oxford bamford classification for stroke, how would you classify lateral medullary syndrome?
GPT -
Although no universally defined “triad” exists for lateral medullary syndrome, a common set of three key symptoms often associated with the condition includes:
Horner’s Syndrome (Ipsilateral) – Ptosis, miosis, anhidrosis (due to disruption of the descending sympathetic fibers).
Crossed Sensory Loss – Ipsilateral facial loss of pain and temperature sensation (spinal trigeminal nucleus) and contralateral body loss of pain and temperature (spinothalamic tract).
Dysphagia/Dysphonia – Due to involvement of the nucleus ambiguus (cranial nerves IX & X), leading to swallowing and voice difficulties.
A 68-year-old patient reports:
Severe headache followed by sudden complete left-sided weakness.
Loss of left-sided sensation.
Visual deficit affecting the entire left visual field.
Question:
Which stroke syndrome does this presentation suggest?
Which artery is likely occluded?
Total Anterior Circulation Syndrome (TACS).
Right Middle Cerebral Artery (MCA).
A 70-year-old patient presents with:
Sudden onset motor weakness of the right hand.
No sensory deficits or higher cortical dysfunction.
Normal visual fields.
Question:
Which stroke syndrome does this presentation suggest?
Which artery or arterial territory is most likely affected?
Lacunar Circulation Syndrome (LACS) (specifically clumsy hand syndrome).
Small perforating arteries, such as the Lenticulostriate arteries.
A 59-year-old patient experiences:
Sudden onset dysphasia.
Weakness in the right arm.
No visual field loss or sensory deficits.
Question:
Which stroke syndrome does this presentation suggest?
Which arterial branch is most likely responsible?
Partial Anterior Circulation Syndrome (PACS).
Branch of the left Middle Cerebral Artery (MCA). or anterior cerebral artery.
A 62-year-old patient complains of:
Sudden vertigo, inability to walk without support.
Loss of coordination in the left arm.
Double vision and dysphagia
Question:
Which stroke syndrome does this presentation suggest?
Which arterial branch is most likely responsible?
Posterior Circulation Syndrome (POCS). - lateral medullary syndrome
Vertebral artery or Posterior Inferior Cerebellar Artery (PICA).
A 74-year-old patient presents with:
Loss of vision in the right visual field in both eyes.
No weakness, sensory loss, or speech difficulties.
Question:
Which stroke syndrome does this presentation suggest?
Which arterial branch is most likely responsible?
Posterior Circulation Syndrome (POCS).
Posterior Cerebral Artery (PCA) (left side).
A 60-year-old patient presents with:
Sudden complete left-sided weakness.
Loss of proprioception and vibration sense on the left.
Tongue deviation to the right when asked to stick it out.
Question:
Which stroke syndrome does this presentation suggest?
Which artery is most likely involved?
Posterior Circulation Syndrome (POCS), specifically Medial Medullary Syndrome.
Branches of the vertebral artery or anterior spinal artery.
Name 1 exam finding that would indicate a haemorrhagic stroke is the more likely dx over an ischaemic one?
papilloedema
How would you take a history from a stroke patient?
(symptoms from the oxford bamford classification + timeline, progression, LOC etc {as in green in image})
There are 3 main neural tracts affects in a stroke. What are the ascending tracts and what are the descending ones? Where do they decussate?
Ascending :
dorsal column - medulla oblongata
spinothalamic - within 1-2 segments of level of injury.
Descending:
corticospinal - medulla oblongata. (85%)
15% at or w/in 1 -2 levels of where the nerve exits via the ventral horn.
