Strokes and TIA's

Question 1

How do the internal carotid arteries form the front section of the circle of willis?

Answer 1

• pass in front of the neck and form the anterior and middle cerebral arteries
• These join anteriorly vis the anterior communicating artery to form the front of the circle of willis

Question 2

How does the basilar artery form the back of the circle of willis?

Answer 2

• At the upper brainstem the basilar artery divides into the two posterior cerebral arteries
• Join to the circle of wilis by 2 small posterior communicating arteries

Question 3

What are the two types of stroke?

Answer 3

1. Haemorrhagic
2. ischaemic

Question 4

What are the 4 types of haemorrhagic strokes?

Answer 4

• Intracerebral
• Subarachnoid
• Subdural
• Extradural

Question 5

What is classified as a subarachnoid haemorrhage?

Answer 5

• Bleeding into thr subarachnoid space

Question 6

what are the three causes of a subarachnoid haemorrhage?

Answer 6

• Rupture of a congenital aneurysm
• anteriovenous malformation (blood vessels tangled in the brain and sometimes burst)
• severe head trauma

Question 7

describe an intracerebral haemorrhage

Answer 7

• Bleeding into deeper parts of the brain
• associated with hypertension
• aterial walls weaken
• micro aneurysms develop
• rupture and bleed

Question 8

describe an extradural haemorrhage

Answer 8

• Bleeding into the extradural space
• Caused by severe trauma tearing the meningeal artery
• Always involves a fractured skull

Question 9

Define each of the classifications of a stroke:

TACS

PACS

POCS

LACS

Answer 9

• TACS - Total anterior circulation stroke
• PACS - Partial anterior circulation stroke
• POCS - Posterior circulation stroke
• LACS - lacumar stroke (deep penetrating arteries)

Question 10

what are the two types of ischaemic stroke?

Answer 10

• Embolic (caused by an embolyis)
• Thrombotic (caused by a thrombos)

Question 11

which is the only type of ischaemic stroke that can develop over several days?

Answer 11

• thrombotic stroke

Question 12

what are the 4 groups of clinical features of a stroke?

Answer 12

• Motor symptoms
• Sensory symptoms
• Speech symptoms
• Cognitive symptoms

Question 13

What are the motor symptoms of a stroke?

Answer 13

• Low tone (flaccidity)
• High tone (spasticity)
• Ataxia (uncoordinated movement)
• Weakness
• Asymmetry
• Loss of normal movement patterns
• Loss of postural adjustments
• loss of balance
• Compensations (to counterbalance)

Question 14

What are the typical spasticity patterns of the upper limb?

Answer 14

Flexor pattern

• Shoulderr elevation and retraction
• Internal rotation and adduction
• Elbow flexion and pronation
• Wrist flexion
• Finger flexion

Question 15

What is the typical spasticity pattern in the lower limb?

Answer 15

Extensor pattern:

• Hip retraction
• Hip extension
• knee extension
• ankle plantarflexion and inversion

Question 16

What are the sensory symptoms of a stroke?

Answer 16

Sensory impairment:

• impared cutaneous sensation
• stereognosis impairment
• proprioceptive impairment

Visual problems (occipital lobe bleed causes this):

• visual field loss
• homonymous hemianopia (only see half the visual field with one or both eyes)

Question 17

What are the speech symptoms of a stroke?

Answer 17

• Disarthria (slurring of speech)
• Expressive dysphasia (cant produce speech)
• Receptive dysphasia (can’t understand speech)
• Global aphasia (can’t understand or produce speech)

Question 18

What are the cognitive symptoms of a stroke?

Answer 18

• Agnosia (unable to recognise objects/sounds using a specific sense)
• Depth perception problems
• Apraxia (can’t order processes)
• Anosagnosia (don’t acknowledge they have a problem)
• Inattention/neglect of affected side

Question 19

What are the other symptoms of a stroke?

Answer 19

• Disorders of emotion
• Dysphagia (delay/absent swallowing reflex)
• Incontinence
• Secondary MSK problems
• Balance/gait problems
• Functional difficulties
• Social problems