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?
According to the oxford bamford classification for stroke, how would you classify lateral medullary syndrome?
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 dysarthria 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.
What is the function of the dorsal columns?
Dorsal Column-Medial Lemniscal Pathway:
Function: Fine touch, vibration, and proprioception.
Pathway:
Fasciculus gracilis: Carries input from the lower limbs.
Fasciculus cuneatus: Carries input from the upper limbs.
Destination: Primary somatosensory cortex via the thalamus.
What is the function of the corticospinal tract?
Corticospinal Tract:
Function: Voluntary movement.
Divisions:
Lateral corticospinal tract: Fine motor control of distal limbs.
Anterior corticospinal tract: Trunk and proximal muscle movements.
What is the function of the spinothalamic tract?
Spinothalamic Tract:
Function: Pain, temperature, and crude touch.
Divisions:
Lateral spinothalamic tract: Pain and temperature.
Anterior spinothalamic tract: Crude touch and pressure.
Destination: Thalamus, then the primary somatosensory cortex.
List some ddx for stroke.
What is a key diagnostic tool involved in the acute assessment of stroke? How are the results interpreted?
What would you expect to find on general inspection of a stroke patient?
Compare a UMN and a LMN in terms of exam findings
+ pronator drift in UMN
Identify the type and some causes of the visual field defect shown.
Monocular vision loss
Identify the type and some causes of the visual field defect shown.
Identify the type and some causes of the visual field defect shown.
Identify the type and some causes of the visual field defect shown.
Superior homonymous quadrantanopia - temporal strokes
Identify the type and some causes of the visual field defect shown.
Inferior homonymous quadrantanopia - parietal strokes
Identify the type and some causes of the visual field defect shown.
macular sparing homonymous hemianopia - POCS
What is the typical gaze palsy seen in POCS. What nerves are affected?
You have been asked to perform a speech exam on a patient with a suspected stroke. Describe how you will do this exam and state the possible findings and its interpretation?
You have been asked to assess neglect in a patient with a suspected stroke. How will you do this test and what are your expected findings?
According to the oxford bamford classification, Which type of stroke presents with:
1. ataxic gait
2. hemiplegic gait
You have performed a UL and LL motor and sensory exam on a stroke patient. You then performed visual field assessments, speech and neglect assessments. What exam findings will you be looking for to confirm the possible etiology of the stroke?
You have been asked to examine a stroke patient for complications of stroke. What exam findings are you looking for?
How would you grade the power of a limb?
Outline the ASIA impairment scale.
What is spinal shock and what are the phases?
In a young person with stroke, what are the possible causes you would suspect?
What are the contraindications for thrombolysis?
What investigations should be done to rule out contraindications for treatment of stroke?
What are the diagnostic investigations for stroke?
What are the acute investigations that should be performed for a stroke patient? Justify each.
What investigations would you order to determine the etiology of a stroke?
How would you investigate for the complications of stroke?
What do this images show?
What are all the investigations for a stroke?
What is the modified rankin scale used for? Outline the scale.
How would you stratify the risk of a TIA?
What are the complications of a stroke?
Outline the acute management of a TIA
Outline the acute management of a hemorrhagic stroke.
If a person is discovered to have a stroke on waking up, how is the time of onset calculated?
Outline the acute management of an ischaemic stroke including dose and timeline.
Explain the procedure of a thrombectomy.
Outline is the long term management and secondary prevention of stroke?
Outline the full management of a TIA.
Outline the full management of a hemorrhagic stroke.
Outline the full management of an ischemic stroke.
