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1st year systems ADAM > Stroke Presentation and Investigation > Flashcards

Stroke Presentation and Investigation Flashcards

1
Q

What is a stroke

A

Neurological deficit (‘loss of function’)
of sudden onset,
Lasting more than 24 hours,
Of vascular origin

Transient Ischaemic Attack< 24 hours

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2
Q

What are the symptoms of a stroke?

A

Loss of power

Loss of sensation

Loss of speech – loss of comprehension or loss of ability

Loss of vision

Loss of coordination

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3
Q

What are the essential things to ask about when taking a history?

A

Time of onset

Witnesses

Headache, vomiting, neck stifness, photophobia

Loss of consciousness

Fit

Incontinence

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4
Q

What is the neurological history likely to be?

A

Motor (clumbsy or weak limb)

Sensory (loss of feeling)

Speech (dysarthia/Dysphasia

Neglect / visospatial problems

Vision: Loss in one eye or hemianopia
Gaze palsy

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5
Q

What are the causes of stroke?

A
  • Blockage of a vessel with thrombus or clot(85% infarction)
  • Disease of vessel wall
  • Disturbance of normal properties of blood
  • Rupture of vessel wall–(15% haemorrhage)
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6
Q

Look at the different arteries

A
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7
Q

What part of the brain does the carotid system supply?

A

The carotid system supplies most of the hemispheres and cortical deep white matter

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8
Q

What does the vertebro-basilar system supply?

A

Brainstem

Cerebellum and occipital lobes

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9
Q

What is the motor cortex responsible for?

A

Movement

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10
Q

What is the frontal lobe responsible for?

A

Judgement, foresight and voluntary movement.

Smell

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11
Q

What is Broca’s arch responsible for?

A

Speech

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12
Q

What is the temporal lobe responsible for?

A

Intellectual and emotional functions

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13
Q

What is the brainstem responsible for?

A

Swallowing, breathing, heartbeat, wakefulness centre and other involuntray functions

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14
Q

What is the cerebellum responsible for?

A

coordination

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15
Q

What is Wernicke’s area responsible for?

A

SPeech comprehension

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16
Q

What is the occipital responsible for?

A

Primary visual area

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17
Q

What is the temproal lobe responsible for?

A

Hearing

18
Q

What is the parietal lobe responsible for?

A

Comprehension of language

19
Q

What is the sensory cortex responsible for?

A

Pain heat and other sensations

20
Q

Summary

A
21
Q

What is the pathophysiology of Ischaemic stroke

A

Results from failure of cerebral blood flow to part of brain
Can be transient
Results in hypoxia and hypoglycaemia

22
Q

What are the causes of ischaemic stroke?

A
  1. Large artery atherosclerosis (e.g. Carotid) 35%
  2. Cardioembolic (e.g. atrial fibrillation) 25%
  3. Small artery occlusion (Lacunar) 25%
  4. Undetermined/Cryptogenic 10-15%
  5. Rare causes <5%
23
Q

What are the causes of haemorrhagic stroke?

A
  1. Primary intracerebral haemorrhage 70%
  2. Secondary haemorrhage 30%
24
Q

What is the most common cause of cardioembolic stroke?

A

Atrial fibrillation - blood that isn’t flowing will clot

25
Q

What vessels does a lacunar stroke involve?

A
26
Q

What are the parts of the brain that can be affected by a stroke?

A

Left or right

Carotid territory or vertibrobasilar territory

Cerebral hemispheres or brainstem

Cortex or deep white matter

27
Q

What do symptoms tell you about the likely diagnosis of the type of stroke?

A

What side of the brain is affected

Whether the lesion is in the brainstem (a brainstem stroke)

Whether the cortex is involved (a cortical stroke)

or if the lesion is in the deep white matter (a lacunar stroke)

What blood vessel is involved

28
Q

Why do we localise the origin of the stroke?

A

Confirms the diagnosis of the stroke

Allows better selection of imaging

Gives an indication of the cause

Gives an indication of the prognosis

29
Q

What are the stroke subtypes?

A

TACS: Total anterior circulation stroke

PACS: Partial anterior circulation stroke

LACS: Lacunar stroke

POCS: Posterior circulation stroke

30
Q

Describe the lesion and what would cause this defect?

A

Unilateral field loss

Left optic nerve compression

31
Q

What is the name of the following visual defect and the example lesion

A

Bilateral hemianopia - chiasmal compression from pituitary tumour

32
Q

What is the visual defect associated and give an example lesion

A

Homonmous hemianopia - left cerebrovascular event.

33
Q

What are the symptoms of total anterior circulation strokes (make up 20% of strokes in the community)?

A

Patient usually has weakness, sensory deficit

Homonymous hemianopia (loss of vision)

Higher cerebral dysfunction (eg dysphasia, dyspraxia)

34
Q

What are the symptoms of Anterior cerebral artery (ACA) stroke

A

paralysis of contra-lateral foot and leg

sensory loss over contra-lateral toes, foot and leg

impairment of gait and stance.

35
Q

What is TACS usually due to?

A

Occlusion of proximal MCA or ICA (Middle carotid artery or internal carotid artery)

36
Q

What are the features of PAC strokes? (35% of strokes)

A

2 of 3 of TACS criteria or restricted motor/sensory deficit

eg. one limb, face and hand or higher cerebral dysfunction alone

37
Q

What causes PACS?

A

Occlusion of branches of MCA - more restricted cortical infarcts

38
Q

What are the features of a lacunar stroke?

A

Pure motor (commonest)

Pure sensory

Sensory symptoms and/or signs, same distribution

Dysarthria- clumsy hand syndrome

Ataxic hemiparesis

39
Q

What is the cause of Lacunar strokes? (20% of strokes)

A

Intrinsic disease of single basal perforating artery (end arteries).

40
Q

What part of the brain does the posterior circulation stroke affect?

A

25% of stroke

Affecting brainstem, cerebellar or occipital lobes.

41
Q

What are the features of a POCS?

A

Bilateral motor/sensory deficit

disordered conjugate eye movement

isolated homonymous hemianopia

ipsilateral cranial nerve palsy with contralateral motor/sensory deficit

coma

disordered breathing

tinnitus

vertigo

Horner’s

Variable, frequently complex presentation (may include any of the above)

42
Q

Summary of the Stroke epidaemiolgy

A

TACS - 20 %

PACS - 35%

POCS - 25%

LACS - 20%

1st year systems ADAM (52 decks)

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