1.9-1.10 stroke

Question 1

arterial blood supply to the brain two soucres

Answer 1

anterior circulation
posterior circulation

Question 2

ACA blockage affected areas clinical names

Answer 2

lower limbs somatosensation and motor deficits

aka contralateral hemiparesis and hemianasthesia

Question 3

non dominant vs dominant and associated hemisphere

Answer 3

left hemisphere = dominant (because it controls the right side)

right hemisphere = non dominant (because it controls the left side

Question 4

non dominant hemisphere and distribution of motor and sensory functions - the unique features that occur when damage to non dominant hemisphere

Answer 4

non dominant hemisphere, while it has motor function it also as more sensory functios, when you get damage to this area along with hemiparesis, hemianopia and sensory loss some unique features include neglect syndrome, and anosognosia = unaware of having deficits

Question 5

unique features that occur when damage dominant hemisphere 3

Answer 5

hemiparesis of face
aphasia
mental cognitive decrease: alexia, agraphia, acalculia, apraxia

Question 6

damage to right MCA 6

Answer 6

responsible for non dominnat hemisphere so:

left hemiparesis
left sensory loss
left homonoymous hemanipopa
neglect syndrome
agsnosgia

Question 7

damage to left MCA 6

Answer 7

controls dominant hemisphere

right hemiparesis
right sensory loss
right homonoymous hemaniopia
global asphasia
dysarthria
mental decline: alexia, agraphia, acalculia, apraxia

Question 8

where is the anterior circulation derived from

Answer 8

internal carotids

Question 9

where is the posterior circulation derived from

Answer 9

vertebrobasilar system

Question 10

superior division of the mca covers key structures including 3

Answer 10

broca’s area
primary motor cortex
primary somatosensory cortex

Question 11

inferior division of the mca covers key structures including

Answer 11

Wernicke’s
Visual input
Langauge interpretation

Question 12

damage to superior division of mca 4

Answer 12

contralateral hemiparesis - more predominant in upper limbs
contraletarl sensory loss - more predominant in upper limbs
expressive aphasia
inferior quadrantaonopia

Question 13

damage to inferior division of the mca 4

Answer 13

no weakness or sensory loss
receptive aphasia
flat effect of speech
superior quadrantanopia

Question 14

what does the aca supply

Answer 14

medial frontal lobe
medial parietal lobe
corpus callosum

hence blockage affects lower limbs more

Question 15

what does pca supply 3

Answer 15

occipital
thalamus
posteriotemporal

Question 16

pca stroke results 3

Answer 16

contralateral homonymous hemianopia
deficits in long and short term memory
hemi sensory loss

Question 17

where does the confluence of the sinuses drain into

Answer 17

internal jugular vein

Question 18

what three sinuses combine to form the confluence of sinuses

Answer 18

straight sinus, superior sagital sinus, transverse sinus

Question 19

what are dural venous sinuses

Answer 19

valvless venous channels located between two layers of the dura

Question 20

two common causes of ischemic stroke

Answer 20

embolic
thrombolic

Question 21

complications of ischemic stroke 3

Answer 21

haemorrhage
cerebral odema
elevated icp

Question 22

why is there the risk of haemorrhage post ischemic stroke? 2

Answer 22

because the emboli/thrombolos causing the stroke often damage the blood vessels

also there will be inflammation causing damage to blood vessels

Question 23

what is the cause of emboli stroke 3

Answer 23

thrombus fragments formed outside of the brain, commonly come up from the heart, block a vessel

Question 24

what is the cause of thrombosis stroke 2

Answer 24

arterial wall damage leading to coagulating and narrowing

commonly occurs at branching

Question 25

where does atherosclerosis commonly occur in the brain 3

Answer 25

internal carotid arteries middle cerebral artery basilar artery

Question 26

transient ischemic attack definitinon

Answer 26

temporary inadequate cerebral perfusion with deficits lasting less than 24hrs.

Question 27

causes of tia 3

Answer 27

- atherosclerosis - thrombus - vasospasm

Question 28

two types of haemorrhagic strokes

Answer 28

intracerebral subarachnoid

Question 29

intracerebral haemorrhage causes 6

Answer 29

chronic hypertension vasculitis bleeding from tumour vascular malformation charcot-bouchard cerebral amyloid angiopathy

Question 30

most common cause of intracerebral haemorrhage

Answer 30

chronic hypertension

Question 31

charcot bouchard anneursym 2

Answer 31

chronic hypertension damages vessel wall leads to lipid hyaline deposit which weakens arterioles

Question 32

subarachnoid haemorrhage cause 4

Answer 32

anneurysms, specifcially berry anneurysms vascular malformations trauma raised icp

Question 33

subarachnoid haemorrhage most common causes 2

Answer 33

anneurysms at circle of willis raised icp

Question 34

berry anneurysms

Answer 34

malformations in vessels whcih commonly occur at circle of willis. the elastic lamina is weaker resulting in rupture and ballooning out.

Question 35

complications of haemorrhagic stroke both ICH+SAH 7

Answer 35

hydrocephalus oedema elevated icp compression herniation ischemia death

Question 36

clinical features of subarachnoid haemorrhage + intracerebral haemorrhage

Answer 36

thunderclap headache nausea + vomitting stiff neck photophobia blurred vision loss of conscioussness seizure

Question 37

investigations in stroke (code stroke) 3

Answer 37

CT scan CT angiogram CT perfusion

Question 38

investigations in tia 2

Answer 38

CT scan CT angiogram

Question 39

ct perfusion shows MTT what is this

Answer 39

mean transient time, how long it takes blood to get to areas of the brain shows penumbra and infarct region

Question 40

rosier assessment tool 2

Answer 40

series of questions used to grade whether someone is code stroke reviewed to stroke team for imaging action

Question 41

what does plain ct show

Answer 41

loss of grey white matter

Question 42

what does a ct angio show

Answer 42

occlusion of a vessel

Question 43

when do we use mri in stroke investigation

Answer 43

to view lacunar strokes

Question 44

the 3 types of ischemic strokes based off severity

Answer 44

global cerebral ischemia focal cerebral ischemia watershed infarct - border zone infarct

Question 45

how does ischemic stroke appear on ct acutely 2

Answer 45

may be normal loss of grey white matter

Question 46

how does ischemic stroke appear subacutely on imaging 2

Answer 46

region of hypodensity oedema- lack of gyri

Question 47

how does ischemic stroke present chronicaly on imaging

Answer 47

parenchyma loss

Question 48

acute management of ischemic stroke

Answer 48

thrombolysis with tPA

Question 49

tpa administration window

Answer 49

should be administered within 4.5hrs after symptom onset, studies extending window to 9hrs

Question 50

surgical intervention for ischemic stroke management

Answer 50

surgical clot removal (thrombectomy)

Question 51

acute management of sub arachnoid haemorrhage 2

Answer 51

anneurysm clipping endovascular coiling

Question 52

acute management of intracerebral haemorrhage 2 (weird)

Answer 52

bp lowering medication blood aspiration

Question 53

pharmacology in stroke management secondary 5

Answer 53

antiplatelet anticoagulant statin diabete treatment hypertension treatment

Question 54

contraindications for antiplatelet 3

Answer 54

intracerebral haemorrhage history of haemorrhage liver disease

Question 55

contraindication for statin 2

Answer 55

pregnancy liver disease

Question 56

non pharmalogical stroke prevention 6

Answer 56

diet more exercise quit smoking quit alcohol reduce stress drug use cessation

Question 57

key early sign of stroke in imaging

Answer 57

hyperdense vessel sign

Question 58

T1 MRI

Answer 58

Fat appears bright, liquid is dark

Question 59

T2 MRI

Answer 59

liquid is bright

Question 60

if there is a stroke whats a key systems review you also need to do along with neurological

Answer 60

cardiovascular, particularly looking for the presence of AF

Question 61

what physical examination findings from a cvd exam indicate atrial fibriliattion 2

Answer 61

irregular irregular pulse high heart rate

Question 62

if they have a haemorrhagic stroke and you notice they are on anticoagulants what can you do?

Answer 62

administer vitamin k and plasma if on warfarin cease all medications immediaetly