Strokes

Question 1

What proportion of strokes are due to ischaemia?

Answer 1

85%. 10% are haemorrhagic and 5% due to things like dissection of venous sinus thrombosis.

Question 2

Where can thromboemboli come from?

Answer 2

The heart- atrial fibrillation/ valvular disease/ prosthetic valves/septic emboli/ intracardiac thrombus

The aorta

Vertebral/basilar arteries

Carotid arteries

Others: vasculitis, sickle cell anaemia, cocaine

Question 3

How will an anterior cerebral artery stroke present?

Answer 3

Contralateral lower limb weakness and loss of sensory modalities. UMN signs.

Question 4

How will a distal middle cerebral artery stroke present?

Answer 4

Contralateral upper limb and face UMN signs and loss of all sensory modalities.

There may also be visual effects- most likely contralateral homonymous hemianopia. More distal occlusion could just cause homonymous superior or inferior quadrantonopia

Speech- depending on which branch affected brocas area and wernickes area can both be affected. (Left side dominance)

If right side is affected in left side dominance then stroke can lead to hemispatial neglect, tactile extinction, visual extinction, anosognosia (believe that they dont have any kind of disability )

Question 5

How will a proximal middle cerebral artery stroke present?

Answer 5

Similar to a distal stroke but this time face, arms and motor component of legs affected as lenticulostriate branches supplying internal capsule are blocked.

Question 6

How will a proximal posterior cerebral artery stroke present?

Answer 6

Contralateral homonymous hemianopia with macular sparing. Loss of thalamoperforator artery leads to loss of sensation on contralateral side.

Question 7

How will a cerebellar artery stroke present?

Answer 7

DANISH

Also brainstem affected so will get cranial nerve signs

Question 8

How will a proximal basilar artery stroke present?

Answer 8

Locked in syndrome- patient can only move their eyes and nothing else

Question 9

How will a distal basilar artery stroke present?

Answer 9

Bilateral occipital lobe infarction- vision loss.
Bilateral thalamic infarction- sensory loss
Bilateral midbrain infarction- cranial nerve signs, motor loss

Question 10

What conditions can mimic a stroke?

Answer 10

HEMI

Hypoglycaemia
Epilepsy
Migraine
Intracranial tumours