Stroke Assessment - Helms

Question 1

Define stroke (in the broadest sense)

Answer 1

A sudden failure of brain function due to diminished blood flow to a part of the brain, or de to bleeding inside the brain

Question 2

Give the two major mechanisms of stoke

What are the 3 P’s discussed that drive stroke occurrance?

Answer 2

Thrombotic and Embolic

Pump (heart), Pipes (vessels), Passengers (blood components)

Question 3

Cardioembolism accounts for about what percentage of strokes?

What two defects or pathological processes does it generally include?

What areas of brain vessels are generally affected? Which major vessel is usualy implicated?

Answer 3

20-30%

Atrial fibrillation and valvular defects

MCA is the most common site, with strokes either affecting large vessels, or end branches along the grey-white border

Question 4

What is the pattern of hypoperfusive damage for:

Low flow

Complete blockage of flow

Answer 4

Low flow: watershed injury

No flow: cortical laminar necrosis

Question 5

Give 3 patterns of large vessel disease often implicated in stroke

Answer 5

Carotid plaque

Vertebral artery stenosis

Intracranial stenosis

Question 6

What is an artery-to-artery embolism?

Answer 6

Rupture of a plaque in an upstream vessel then travels downstream to occlude another (probably smaller) vessel

Question 7

Name 5 areas of the brain especially vulnerable to lacunes and hemorrhages

Answer 7

• Basal ganglia
• Pons
• Thalamus
• Certrum semiovale
• Cerebellum

Question 8

Where in vessels do aneurysms usually occur?

Are these common or rare?

Answer 8

At bifurcation sites

Rare

Question 9

Describe the presentation of ateriovenous malformation

Answer 9

Highly variable

• Hemorrhage
• Focal neurological symptoms
• Seizures
• Headaches
• Or nothing (asymptomatic)!