YearClub 2026 Neurology session (cerebrovascular events) Flashcards
Symptoms of ischaemic stroke? What are the associated syndromes?
- 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
What is homonymous hemianopia?
A field loss deficit in the same halves of the visual field of each eye, often resulting from cerebrovascular injury or tumor.
What is sensory neglect?
Inability to perceive, report and orient to sensory events towards one side of space, contralateral to the side of the lesion
Layers of the brain?
Skin (SCALP)
- Skin
- Connective tissue
- Aponeurosis
- Loose connective tissue
- Periosteum
Bone
Dura mater
Arachnoid mater
Subarachnoid space
Pia mater
Brain
Cause of epidural (extradural) haemorrhage?
Commonly due to trauma, causing fracture of the pterion of the temporal bone, which ruptures the middle meningeal artery which runs underneath
For epidural haemorrhage, trauma is followed by unconsciousness, then a brief period of recovery, followed by further decline in GCS. True/false?
True
The patient may keep declining due to expanding haematoma until coning of the brainstem causing fixed dilated pupils, respiratory arrest, and death
Epidural haemorrhage on non-contrast CT?
Investigation: Non-contrast CT (biconvex lens shape)/lemon shaped
Treatment for epidural haemorrhage?
Urgent neurosurgical review → decompression burr hole surgery
Who is most at risk of subdural haemorrhage?
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
Presentation of subdural haemorrhage?
Presentation (can fluctuate over time):
Worsening headaches
N&V, vision, speech, gait
Confusion/cognitive impairment
Hemiparesis
Subdural haemorrhage on CT scan?
Crescent shaped
Bright white = fresh (acute)
Dark = old (chronic)
Treatment of subdural haemorrhage?
Conservative mx - “watchful waiting”
Mannitol if raised ICP
Repeat CT in 6 months
Surgical treatment of subdural haemorrhage?
Surgical mx - Craniotomy
If large & symptomatic
Post-op pain control & anti-emetics
Repeat CT in 2-3 days
What is CT appearance of subarachnoid haemorrhage?
Makes outline of brain
What is a subarachnoid haemorrhage? Cause and associated risk factors?
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.
What is subarachnoid haemorrhage clinical presentation?
Sudden, intense, occipital, ‘thunderclap’ headache, followed by photo/phonophobia, neck stiffness, decreasing GCS
Subarachnoid haemorrhage treatment?
Stop anticoagulants, ↓ICP (mannitol), nimodipine
Where does intracerebral haemorrhage occur?
In the brain
Intracerebral haemorrhage risk factors?
HTN (hypertension), arteriovenous malformations
Why is CT required for intracerebral haemorrhage?
Similar to ischaemic stroke, hence why CT required.
Need to be aware of intracerebral haemorrhage but symptoms are indistinguishable from ischaemic stroke.
Ischaemic stroke to which area of the brain will cause slow and broken speech?
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
Ischaemic stroke to which area of the brain will cause wording that doesn’t make sense (speech itself will be normal)?
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
What nerve palsy is commonly associated with a subarachnoid haemorrhage?
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.
Presentation of a lacunar stroke?
presents with 1 of the following:
- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
- pure sensory stroke.
- ataxic hemiparesis
What is ataxic hemiparesis?
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.
What arteries are usually involved in a lacunar stroke?
Involves perforating arteries around the internal capsule, thalamus and basal ganglia