YearClub 2026 Neurology session (cerebrovascular events)

Question 1

Symptoms of ischaemic stroke? What are the associated syndromes?

Answer 1

• Hemiplegia (one sided body paralysis)
• Hemisensory loss
• Homonymous hemianopia
• Dysphasia (disorder in speaking and understanding spoken language).
• Sensory neglect

Total Anterior Circulation Syndrome (TACS) - 3/+

Partial Anterior Circulation Syndrome (PACS) - 2-3

Lacunar-Cerebral Syndrome (LACS) - 1

Posterior Circulation Syndrome (POCS) - affects cranial nerves

Question 2

What is homonymous hemianopia?

Answer 2

A field loss deficit in the same halves of the visual field of each eye, often resulting from cerebrovascular injury or tumor.

Question 3

What is sensory neglect?

Answer 3

Inability to perceive, report and orient to sensory events towards one side of space, contralateral to the side of the lesion

Question 4

Layers of the brain?

Answer 4

Skin (SCALP)
- Skin
- Connective tissue
- Aponeurosis
- Loose connective tissue
- Periosteum

Bone

Dura mater

Arachnoid mater

Subarachnoid space

Pia mater

Brain

Question 5

Cause of epidural (extradural) haemorrhage?

Answer 5

Commonly due to trauma, causing fracture of the pterion of the temporal bone, which ruptures the middle meningeal artery which runs underneath

Question 6

For epidural haemorrhage, trauma is followed by unconsciousness, then a brief period of recovery, followed by further decline in GCS. True/false?

Answer 6

True
The patient may keep declining due to expanding haematoma until coning of the brainstem causing fixed dilated pupils, respiratory arrest, and death

Question 7

Epidural haemorrhage on non-contrast CT?

Answer 7

Investigation: Non-contrast CT (biconvex lens shape)/lemon shaped

Question 8

Treatment for epidural haemorrhage?

Answer 8

Urgent neurosurgical review → decompression burr hole surgery

Question 9

Who is most at risk of subdural haemorrhage?

Answer 9

Usually in older people/ chronic alcoholics- they have basically shrinking brains which means the emissary veins will be stretched further, thus are likely to burst with minor trauma in the subdural area

Question 10

Presentation of subdural haemorrhage?

Answer 10

Presentation (can fluctuate over time):

Worsening headaches
N&V, vision, speech, gait
Confusion/cognitive impairment
Hemiparesis

Question 11

Subdural haemorrhage on CT scan?

Answer 11

Crescent shaped

Bright white = fresh (acute)
Dark = old (chronic)

Question 12

Treatment of subdural haemorrhage?

Answer 12

Conservative mx - “watchful waiting”
Mannitol if raised ICP
Repeat CT in 6 months

Question 13

Surgical treatment of subdural haemorrhage?

Answer 13

Surgical mx - Craniotomy
If large & symptomatic
Post-op pain control & anti-emetics
Repeat CT in 2-3 days

Question 14

What is CT appearance of subarachnoid haemorrhage?

Answer 14

Makes outline of brain

Question 15

What is a subarachnoid haemorrhage? Cause and associated risk factors?

Answer 15

Have bleeding in the subarachnoid space between the arachnoid mater and pia mater.

Commonly due to rupture of aneurysm in the circle of willis.

Risk factors include hypertension, ADPKD, family history, collagen disorders, and AVMs.

Question 16

What is subarachnoid haemorrhage clinical presentation?

Answer 16

Sudden, intense, occipital, ‘thunderclap’ headache, followed by photo/phonophobia, neck stiffness, decreasing GCS

Question 17

Subarachnoid haemorrhage treatment?

Answer 17

Stop anticoagulants, ↓ICP (mannitol), nimodipine

Question 18

Where does intracerebral haemorrhage occur?

Answer 18

In the brain

Question 19

Intracerebral haemorrhage risk factors?

Answer 19

HTN (hypertension), arteriovenous malformations

Question 20

Why is CT required for intracerebral haemorrhage?

Answer 20

Similar to ischaemic stroke, hence why CT required.

Need to be aware of intracerebral haemorrhage but symptoms are indistinguishable from ischaemic stroke.

Question 21

Ischaemic stroke to which area of the brain will cause slow and broken speech?

Answer 21

Broca’s area in the inferior frontal gyrus (located in frontal lobe).

Remember:
Broca’s area (non fluent speech)
mOTOR
fRONTAL LOBE
Speech is slow and broken

B = broken words

Mnemonic:
bROCA mOTOR fRONTAL =

bAD mOTHER f*CKER

Question 22

Ischaemic stroke to which area of the brain will cause wording that doesn’t make sense (speech itself will be normal)?

Answer 22

Wernicke’s area in the posterior section of the superior temporal gyrus (located in temporal lobe).

Remember:
Wernike’s area (fluent speech)
Sensory
Occurs in temporal lobe
Speech is normal and excessive but makes little sense.

W = Wacky Words or Word salad

Question 23

What nerve palsy is commonly associated with a subarachnoid haemorrhage?

Answer 23

CN 3 (oculomotor) nerve palsy.

Pupil would appear dilated and deviated down and outwards this is due to rupture of posterior communicating artery close to CN 3.

Question 24

Presentation of a lacunar stroke?

Answer 24

presents with 1 of the following:

1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

Question 25

What is ataxic hemiparesis?

Answer 25

Ataxic hemiparesis is a condition characterized by weakness and incoordination on one side of the body. It is caused by disease activity in the cerebellum.

Ataxia is a condition where a person has trouble coordinating their voluntary muscle movements.

Question 26

What arteries are usually involved in a lacunar stroke?

Answer 26

Involves perforating arteries around the internal capsule, thalamus and basal ganglia