strokes

Question 1

clinical features of MCA stroke

Answer 1

most commonly affected vessel
contralateral weakness and sensory loss more marked in the upper limbs and lower half of the face than in lower limbs
gaze deviates towards side of infarction

Question 2

clinical features of anterior cerebral artery stroke

Answer 2

ACA
contralateral weakness and sensory loss in the lower limbs more marked than in upper limbs

Question 3

clinical features of posterior cerebral artery stroke

Answer 3

contralateral homonymous hemianopia with macular sparing due to occipital lobe involvement
contralateral sensory loss due to lateral thalamic involvement: light touch, pinprick, and positional sense may be reduced
memory deficits
vertigo, naesea

Question 4

posterior inferior cerebellar artery

Answer 4

lateral medulary syndrome

Question 5

anterior inferior cerebellar artery

Answer 5

lateral pontine syndrome

Question 6

lenticulostriate arteries

Answer 6

lacunar syndrome

Question 7

basilar artery

Answer 7

consciousness is preserved if the reticular activating system is not effected
vertebrobasilar insifficiency:
vertigo, drop attacks, tinnitus, hiccups, dysarthria, dysphagia
diplopia, gait ataxia, paresthesias
pontine syndromes
cerebellar syndromes

Question 8

cortical signs

Answer 8

neglect, aphasia, visual feild loss

Question 9

frontal lobe controls

Answer 9

movement and executive function

Question 10

parietal lobe controls

Answer 10

sensory info

Question 11

cerebellum controls

Answer 11

muscle coordination

Question 12

brainstem controls

Answer 12

heart rate, BP, breathing, GI function, consciousness

Question 13

the right cerebrum controls

Answer 13

muscles on the left

Question 14

vertebral arteries and basillar arteries supply

Answer 14

cerebellum and brainstem

Question 15

cerebral arteries supply

Answer 15

lateral portions of frontal, parietal and temporal lobes

Question 16

anterior cerebral arteries supply

Answer 16

medial portions of the frotal and parietal lobes
connect via the anterior communicating arteries

Question 17

basilar arteries divide to become

Answer 17

right and left posterior cerebral artery
occipital lobe and some of the termporal lobe and thalamus

Question 18

lacunar strroke

Answer 18

involves deep branches of the middle cerebral artery that feed the basal ganglia
develops cysts
typically caused by hyaline atherosclerosis caused by diabetes or hypertension causing thick walls and reducing the size of the lumen

Question 19

ischaemic core

Answer 19

brain tissue likely to die from ischaemia

Question 20

ischaemic penumbraa

Answer 20

preserved by collateral circulation
has a chance to survive if circulation is restored

Question 21

swelling on brain

Answer 21

swollen brain tissue can push onto unaffected side of the brain
cerbellar tonsil hernation - may push onto the brainstem and affect breathing and consciousness

Question 22

anterior or middle cerebral artery stroke

Answer 22

numbness and weakess

Question 23

posterior cerebral artery stroke affects

Answer 23

vision

Question 24

TPA

Answer 24

thrombolitic enzyme
tissue plasminogen activator
activates body’s clot dissolving mechanisms
has a time limit for usage

Question 25

subarachnoid haemorrhage

Answer 25

haemorrhage occurs between pia mater and subarachnoid mater of the meninges

Question 26

causes of subarachnoid haemorrhage

Answer 26

ruptured berry aneurysm
arterriovenous malformation
trauma

Question 27

clinical features of subarachnoid heamorrhage

Answer 27

rapid onset severe headache
meningeal signs: nuchal rigidity, headache, photophobia
sudden onset of focal neurologicaal deficits

Question 28

clinical features of intracerebral haemorrhage

Answer 28

headache, confusion, nausea
sudden onset focal neurological deficits

Question 29

diagnosis of subarachnoid haemorrhage

Answer 29

non contrast head CT to rule out haemorrhage)
MRI
CTA/MRA
lumbar puncture (if imaging is negative but clinical suspicion of subarachnoid remains high - may show xanthochromia)

Question 30

xanthochromia

Answer 30

presence of bilirubin in the CSF secondary to the breakdown of RBCs, resulting in yellow discolouration

Question 31

findings of ischaemic stroke on non-contrast CT

Answer 31

hyperdense MCA sign
effacement of sulci
loss of conrtico-medullary differentiation
oedema

Question 32

findings of intracerebral haemorrhage

Answer 32

hyperdense lesion within the cerebral parenchyma

Question 33

findings of subarachnoid haemorrhage on non-contrast CT

Answer 33

extensive area of hyperdense signals around the. circle of willis (most common location)

Question 34

treatment of ischaemic stroke

Answer 34

tPA (if within <4.5 hours of onset of symptoms)
intra-arterial thrombolysis
thrombectomy
aspirin or clopidogrel for secondary prevention i

Question 35

tPA

Answer 35

tissue plsminogen activator
A serine protease found on endothelial cells of the blood vessels. Catalyzes the conversion of plasminogen to plasmin, which is the main enzyme responsible for clot breakdown. Recombinant tissue plasminogen activators (e.g., alteplase, reteplase, tenecteplase) are used as thrombolytics in patients with acute coronary syndrome, pulmonary embolism, or ischemic stroke.

Question 36

thrombolysis

Answer 36

The pharmacologic breakdown of blood clots formed in vessels. Indications include STEMI, stroke, massive pulmonary embolism, severe deep vein thrombosis, and acute limb ischemia. Agents used include streptokinase and alteplase.

Question 37

treatment of intracerebral haemorrhage

Answer 37

reversal of coagulopathy
blood pressure management
surgical intervention if there are signs of herniation or increased ICP

Question 38

treatment of subarachnoid haemorrhage

Answer 38

reversal of coagulopathy
blood pressure management
prevention of vasospasm
surgical clipping
endovasular coiling

Question 39

visual feild defects in MCA stroke

Answer 39

contralateral homonymous hemianopia or superior/inferior quadrantopia
without macular sparing

Question 40

macular sparing

Answer 40

A phenomenon in which macular vision is preserved despite adjacent visual field defects (e.g., in homonymous hemianopia due to a posterior cerebral artery stroke).

Question 41

manifestations of MCA infarction

Answer 41

Question 42

cerebellar syndromes

Answer 42

A characteristic set of symptoms associated with dysfunction of the cerebellum. Typical symptoms include ataxia, imbalance, uncoordinated movements (dysmetria), dysarthria, and oculomotor disorders (e.g., nystagmus).

Question 43

manifestations of basilar artery stroke

Answer 43

consciousness is preserved is the reticular activating system is not affected
vertebrobasilar insufficiency: vertigo, drop attackes, tinnitus, hiccups, dysarthria, dysphagia, diplopia, gait ataxia, paresthesis

Question 44

amaurosis fugax

Answer 44

sudden, painless loss of vision that lasts for seconds to minutes and is followed by spontaneous recovery (mostly unilateral)

Question 45

lacunar stroke

Answer 45

A subcortical stroke that is primarily associated with hypertension and diabetes mellitus. Lipohyalinotic thickening of vessel walls results in the occlusion of small, penetrating arteries that supply the subcortical regions of the brain (internal capsule, pons, thalamus, putamen, and caudate). Typically presents as specific lacunar syndromes that are characterized by the absence of cortical signs (e.g., aphasia, hemianopsia, agnosia, apraxia).

Question 46

lacunar infarcts will have an absense of _

Answer 46

cortical signs
eg. aphasia, neglect, visual feild loss, apraxia, agnosia

Question 47

dysarthria

Answer 47

A condition of impaired articulation resulting from motor dysfunction of the tongue, lips, or vocal cords. Typical pathologic speech patterns include slurring, mumbling, staccato pronunciation, and changes in speed and pitch.