Types Of Stroke

Question 1

Presentation of inferior division mca stroke
Motor loss?
Aphasia?
Eye deviation?
Other?

Answer 1

Superior quadrantanopia or homonymous hemianopsia.
Dominant hemisphere/left side - wernicke’s aphasia
Nondominant hemisphere/right side - left visual hemineglect

Question 2

What part of the brain when affected causes conduction aphasia

Answer 2

Parietal operculum supplied by inferior division of MCA

Question 3

What separates superior from inferior division of mca

Answer 3

Sylvian sulcus

Question 4

%age of cardiac emboli that go to brain

Answer 4

75%

Question 5

Which arteries supply the medulla?

Answer 5

Vertebral arteries

Question 6

Which stroke is most commonly associated with preceding TIA

Answer 6

Thrombotic

Question 7

What arteries are occluded in lacunar strokes

Answer 7

Deep penetrating branches of large vessels

Question 8

Weber Syndrome
What part of brain affected?
Motor loss?
CN involved?

Answer 8

Base of Midbrain stroke - Oculomotor nerve (CN3) palsy and contralateral hemiplegia, contralateral dystaxia, caused by interpeduncular branches of PCA.

Question 9

Which arteries supply the pons and midbrain

Answer 9

Basilar artery

Question 10

Presentation of one ACA
Motor loss?
Eye deviation?
Aphasia?
Other?

Answer 10

Contralateral muscle and sensory loss of lower extremity dismally.
Head and eye deviation toward lesion.
Urinary incontinence with contralateral grasp reflex and paratonic rigidity (gegenhalten).
Transcortical motor aphasia.
Gait apraxia

Question 11

Gegenhalten

Answer 11

Paratonic rigidity - form of hypertonic with involuntary variable resistance with passive movement. Different from spasticity because there is no exaggerated DTR. Seen in ACA stroke

Question 12

Branches of aortic arch

Answer 12

Brachiocephalic artery (which branches into R subclavian and R common carotid)
L common carotid artery
L subclavian artery

Question 13

Which part of brain causes alexia with agraphia

Answer 13

Posterior parietal region, supplied by inferior division of MCA

Question 14

Which strokes occur suddenly vs gradually?

Answer 14

Sudden = embolic and subarachnoid
Gradual = thrombotic and intracerebral
Sudden or gradual = lacunar

Question 15

What does inferior division of mca supply?

Answer 15

Lateral temporal and inferior parietal lobes

Question 16

Where is primary somatosensory cortex located

Answer 16

Prostcentral gyrus (behind central sulcus)

Question 17

How do lacunar strokes present?

Answer 17

Pure motor or pure sensory

Question 18

What does superior division of MCA supply?

Answer 18

Rolandic and pre-rolandic area

Question 19

Which ischemic stroke occurs during sleep vs awake

Answer 19

Sleep = thrombotic
Awake = embolic

Question 20

What major vessels supply anterior circulation of brain

Answer 20

ICA, MCA, ACA

Question 21

%age of ischemic vs hemorrhagic stroke

Answer 21

Ischemic = 85%
hemorrhagic = 15%

Question 22

Transcortical sensory aphasia

Answer 22

+fluency
-Comprehension
+Repetition
Caused by PCA stroke

Question 23

Which stroke is due to a mural thrombus

Answer 23

Embolic

Question 24

What cranial nerves are affected with PCA stroke

Answer 24

CN3 (oculumotor) and 4 (Trochlear)

Question 25

%age of thrombotic vs embolic vs lacunar vs intracerebral vs subarachnoid

Answer 25

``` Thrombotic = 50% Embolic = 20% Lacunar = 15% Intracerebral = 10% Subarachnoid = 5% ```

Question 26

Cardiac causes of embolic stroke

Answer 26

A fib, rhd, post-mi, vegetations on heart valves, endocarditis, prosthetic heart valves

Question 27

Where does the PCA stem from?

Answer 27

Vertebral artery --> Basilar artery --> PCA

Question 28

Anton Syndrome

Answer 28

Denial of cortical blindness, caused by PCA stroke

Question 29

Prosopagnosia

Answer 29

Can't read faces, caused by PCA stroke

Question 30

What is the cause of amaurosis fugax

Answer 30

Transient monocular blindness results from ica occlusion as it nourishes the optic nerve and retina

Question 31

What happens if both ACA is occluded?

Answer 31

Aphasia, paraplegia, incontinence, frontal lobe/personality dysfunction

Question 32

Other causes of embolus other than cardiogenic

Answer 32

Fat embolus from fracture bones, air embolus from decompression sickness, venous clot from PFO, subclavian artery thrombosis to vertebral artery

Question 33

Which stroke is associated with seizures

Answer 33

Embolic

Question 34

Which artery supplies cerebellum

Answer 34

PICA from vertebral arteries | AICA and superior cerebellar arteries from basilar artery

Question 35

Types of hemorrhagic strokes

Answer 35

Intracerebral and subarachnoid

Question 36

Where is most common location for ICA to be occluded

Answer 36

First part of ICA immediately beyond carotid bifurcation

Question 37

Which hemorrhagic stroke occurs when calm vs during activity

Answer 37

``` Calm = intracerebral Activity = subarachnoid ```

Question 38

What artery is occluded in ocular infarction

Answer 38

Central retinal artery or retinal branch of ica

Question 39

Where is primary motor cortex located

Answer 39

Precentral gyrus - in front of central sulcus

Question 40

What part of ACA occlusion is well tolerated

Answer 40

Stem of ACA proximal to connection with anterior communicating artery because of collateral circulation with contralateral ACA

Question 41

MCC of occlusion of superior division of MCA

Answer 41

Embolus

Question 42

Types of ischemic strokes

Answer 42

Embolic, thrombotic, lacunae

Question 43

Where are lacunar strokes mainly seen

Answer 43

Putamen, pons, thalamus, caudate nucleus, internal capsule

Question 44

Palinopsia

Answer 44

Abnormal recurring visual imagery, caused by PCA stroke

Question 45

What kind of aphasia is seen in vertebrobasilar strokes

Answer 45

No aphasias or cognitive deficits are seen

Question 46

Presentation of distal ica occlusion: | Arteries involved?

Answer 46

ICA branches into MCA, so it may affect all or part of ipsilateral MCA, and part of ACA. Present with contralateral motor and/or sensory symptoms.

Question 47

``` Presentation of superior division of MCA stroke: Motor loss? Eye deviation? Aphasia? Other? ```

Answer 47

Sensory and motor deficits of contralateral face and arm > leg. Head and eyes deviate toward infarct. dominant hemisphere - Global aphasia --> broca's Nondominant hemisphere - Spatial perception, hemineglect, constructional and dressing apraxia

Question 48

Which division of MCA supplies broca's area, and which supplies wernicke's

Answer 48

``` Superior = broca's Inferior = wernicke's ```