Stroke- types and medications

Question 1

brain supplied from

Answer 1

2 vertebral arteries- go through vertebra in cervical spine- TP in foramina and joint in front of brainstem=basilar artery, 2 internal carotid arteries- come up front of neck, and divide to form anterior and middle cerebral arteries
2 ACA’s join anteriorly via the anterior communicating artery- front section of circle of Willis

Question 2

circle of willis

Answer 2

vertebral artery come up the back and form basilar arteries (supplies back of brain- cerebellum- brain stem), this then forms circle with 2 internal carotid arteries, this then divides into anterior/ middle/ posterior cerebral arteries

Question 3

what does upper brainstem and basilar arteries divide into

Answer 3

2 posterior cerebral arteries- connect to back of circle of Willis by 2 small posterior communicating arteries

Question 4

circle of Willis

Answer 4

occlusion of one internal carotid does not necessarily result in stroke- have another one, brain may be protected from bilateral carotid through basilar supply, end arteries (no connections)- ACA, MCA, PCA

Question 5

which parts of the brain are supplied by each artery- middle cerebral artery

Answer 5

most of the outer surface, sensorimotor cortex- parietal lobe, basal ganglia- movement memories store dhere, internal capsule- where sensory and motor pathways go through, broca’s area

Question 6

which parts of the brain are supplied by each artery- anterior and posterior cerebral artery

Answer 6

anterior- frontal lobe, medial part of sensorimotor cortex, posterior- occipital lobe, medial aspect of temporal lobe, thalamus

Question 7

which parts of the brain are supplied by each artery- basilar artery

Answer 7

all of the brainstem- vital control centre, cerebellum, nuclei of cranial nerves

Question 8

what is a stroke

Answer 8

this is a rapidly developing clinical signs and symptoms of focal and at times global loss of vertebral function lasting more than 24 hours or that lead to death, no apparent cause other than vascular

Question 9

what is a TIA

Answer 9

transient ischemic attack- mini stroke- a sign that part of the brain is not getting enough blood, and there is a risk of more serious stroke in the future. it used to be considered symptoms lasting less than 24 hours, but now is 2 hours

Question 10

types of strokes

Answer 10

classified according to underlying pathology- hemorrhagic and ischemic- classified according to site and extent of lesion

Question 11

Bamford classification of ischaemic stroke

Answer 11

based on the area of brain involved and extent of lesion: TACS- total anterior circulation stroke, PACS- partial anterior circulation stroke, POCS- posterior circulation stroke, LACS- lacunar stroke (deep penetrating arteries)

Question 12

Anterior circulation stroke and PACS- diagnosis

Answer 12

all 3- unilateral weakness (and/or sensory deficit) of face/ arm / leg
homonymous hemianopia
higher cerebral dysfunction
PACS- 2 of the following

Question 13

POCS- diagnosis

Answer 13

one of- cerebellar or brainstem syndromes, loss of consciousness, isolated homonymous hemianopia

Question 14

LACS- diagnosis

Answer 14

one of- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg, or all 3
pure motor/sensory stroke, ataxic hemiparesis

Question 15

ischaemic stroke

Answer 15

80% stroke due to occlusion- atheroma of cerebral arteries, blood clot in the brain or neck- thrombosis, blot clot from somewhere else that has moved and now blocks a blood vessel in the brain/neck= embolism

Question 16

where are ischaemic strokes common

Answer 16

MCA>PCA>ACA, brain stem stroke less common but more serious

Question 17

embolic stroke

Answer 17

completed stroke- sudden onset, TIA- repeated small emboli, no infraction occurs

Question 18

thrombotic stroke

Answer 18

usually develops overnight- completed stroke

developing stroke- develop over several days, TIA- sudden- full recovery- 20% risk of full CVA within first 4 weeks

Question 19

medical management of emboli/ thrombus

Answer 19

treat as medical emergency, MRI/CT scan within 5 hours, ischemic stroke- aspirin, anticoagulants, thrombolysis, TIA- aspirin, prevention work

Question 20

medical management of emboli/ thrombus- other tests and surgery

Answer 20

blood tests, angiography, echocardiology

surgery- thrombectomy- remove fatty deposits, carotid endarterectomy- scrape fatty deposits

Question 21

haemorrhagic strokes

Answer 21

intracerebral haemorrhage, subarachnoid haemorrhage (in arachnoid space- under), subdural hemorrhage (under dura matter), extradural haemorrhage (outside dura matter)

Question 22

what is pia matter

Answer 22

covers the brain- next layer is the arachnoid layer (all capillaries in this area)- final layer- very robust and strong

Question 23

subarachnoid haemorrhage

Answer 23

bleeding into subarachnoid space, due to rupture of congenital aneurysm, arteriovenous malformation (AVM) or trauma, associated with sudden intense headache/ vomiting/ neck stiffness and loss of consciousness
approx 10% die within 1st 2 hours 40% die within 2 weeks

Question 24

extradural haemorrhage

Answer 24

bleeding into extradural space, caused by severe trauma and tearing of meningeal artery

Question 25

medical management of haemorrhagic stroke

Answer 25

treat as medical emergency, MRI/CT scan, SAH- surgery or endoplasmic procedure, SDH/EDH/ICH- treat hypertension, other tests- blood tests, angiography, echocardiology, other medication- osmotic agents

Question 26

bleed vs blockage- loss of consciousness, headache, nausea and vomiting

Answer 26

bleed- at presentation, the rule, frequent

blockage- unusual, occasional, posterior fossa

Question 27

bleed vs blockage- coma, stuttering course, previous TIA’s

Answer 27

bleed- frequent, rarely, very unusual, blockage- late if at all, frequent, sometimes