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Sem 4 - Nervous System > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a stroke?

A

Damage or death of brain cells

Due to ischaemic hypoxia of those brain cells

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2
Q

What is a transient ischaemic attack TIA?

A

Stroke that recovered within 24 hours from the onset of symptoms

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3
Q

What is stroke syndrome?

A

Group of signs and symptoms produced

Due to blockage of an artery supplying part of the brain

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4
Q

What are the types of stroke? Which is the most common?

A

Ischaemic - most common

Haemorrhagic

Dissection

Venous sinus thrombosis

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5
Q

What causes blockage of arteries supplying the brain? What is the most common cause?

A

Embolus - most common cause

Vasculitis

Sickle cell anaemia

Cocaine

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6
Q

Where do emboli blocking arteries supplying the brain arise from? Which is the most common source?

A

Carotid arteries - most common

The heart e.g. atrial fibrillation, valvular disease, prosthetic valves, endocarditis

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7
Q

How does cocaine cause blockage of the arteries supplying the brain?

A

Causes vasoconstriction of the arteries

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8
Q

What are the signs and symptoms of anterior cerebral artery stroke syndrome?

A

Sensory symptoms
-loss of all sensory modalities in the contralateral lower limb

Motor symptoms
-initial hypotonia, followed by hypertonia paralysis in contralateral lower limb

Loss of voluntary control over micturition

Split brain syndrome
Alien hand syndrome

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9
Q

Why does anterior cerebral artery stroke syndrome cause loss of voluntary control over micturition?

A

Damage to cortical centres that voluntarily inhibit micturition reflex

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10
Q

Why does anterior cerebral artery stroke syndrome cause split brain syndrome and alien hand syndrome?

A

Damage to corpus callosum

The two cerebral hemispheres cannot communicate with each other and are in disagreement with each other

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11
Q

Is a middle cerebral artery stroke syndrome with a proximal or distal blockage more severe?

A

Proximal blockage

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12
Q

What is an immediate complication of a middle cerebral artery stroke syndrome with a proximal blockage?

A

Significant amount of damaged and dead brain tissue
Significant cerebral oedema
Raised intracranial pressure
May lead to coma and death

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13
Q

How is raised intracranial pressure with a middle cerebral artery stroke syndrome with a proximal blockage treated?

A

Decompressive hemicraniectomy

-refers to removing half of the skull to relieve the pressure inside the skull

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14
Q

What do the signs and symptoms of middle cerebral artery stroke syndrome depend on?

A

How proximal or distal the blockage is

-to the lenticulo-striate arteries

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15
Q

What are the signs and symptoms of middle cerebral artery stroke syndrome with a proximal blockage?

A

Sensory symptoms
-loss of all sensory modalities in contralateral side of face and upper limb

Motor symptoms
-initial hypotonia, followed by hypertonia paralysis, in whole contralateral side of body

Homonomous hemi-anopia

Global aphasia if dominant hemisphere affected
Neglect if non-dominant hemisphere affected

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16
Q

Why does middle cerebral artery stroke syndrome with a proximal blockage cause paralysis in the whole contralateral side of the body?

A

Due to lenticulo-striate arteries not supplying internal capsule
So all upper motor neurones are damaged or dead

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17
Q

What are the signs and symptoms of middle cerebral artery stroke syndrome with a distal blockage?

A

Sensory symptoms
-loss of all sensory modalities in the contralateral side of the face and the upper limb

Motor symptoms
-initial hypotonia, followed by hypertonia paralysis in contralateral side of face and upper limb

Quadrantanopia

If dominant hemisphere affected, Broca’s or Wernicke’s aphasia
If non-dominant hemisphere affected, neglect

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18
Q

Why does middle cerebral artery stroke syndrome cause visual field defects?

A

Damage to superior and inferior optic radiations in the parietal and temporal lobes

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19
Q

Why does middle cerebral artery stroke syndrome cause aphasia?

A

Damage to Broca’s and Wernicke’s area

20
Q

What is neglect?

A

Patient fails to acknowledge one half of their body and the external environment
That is not due to a lack of sensation, but a lack of processing

21
Q

What are the signs and symptoms of posterior cerebral artery stroke syndrome?

A

Homonymous hemianopia

Macular sparing

22
Q

Why does posterior cerebral artery stroke syndrome cause homonymous hemianopia?

A

Damage to superior and inferior optic radiations in occipital lobe

23
Q

What do the signs and symptoms of a cerebellar artery stroke syndrome depend on?

A

How proximal or distal the blockage is

24
Q

What are the signs and symptoms of cerebellar artery stroke syndrome with a proximal blockage?

A

Brainstem symptoms
-crossed deficits

Cerebellum signs
-DANISH

25
Q

What are crossed deficits?

A

Ipsilateral symptoms on head and neck due to damage to cranial nerve nuclei

Contralateral symptoms in rest of body due to damage to cerebral peduncles

26
Q

What are the signs and symptoms of a cerebellar artery stroke syndrome with a distal blockage?

A

Cerebellum symptoms

-DANISH

27
Q

What do the signs and symptoms of basilar artery stroke syndrome depend on?

A

How proximal or distal the blockage is

28
Q

What are the signs and symptoms of basilar artery stroke syndrome with a proximal blockage?

A

Locked-in syndrome

29
Q

What causes locked-in syndrome?

A

Reduced blood supply to pons

30
Q

Why structures and functions are lost in locked-in syndrome?

A

Ventral pons contains corticospinal tract, loss of motor control over the body

Pons and medulla contain cranial nerve nuclei 5-12, loss of function of cranial nerves 5-12

31
Q

What structures and functions are preserved in locked-in syndrome?

A

Reticular activating system, hence are conscious

Sensory system, hence are aware of environment

Cranial nerves 1-4, hence can make eye moments

32
Q

What are the signs and symptoms of basilar artery stroke syndrome with a distal blockage?

A

Blindness

Loss of sensation

CN3 oculomotor nerve palsy

33
Q

Why does basilar artery stroke syndrome with a distal blockage give blindness?

A

Damage and death of both occipital lobes

34
Q

Why does basilar artery stroke syndrome with a distal blockage give loss of sensation?

A

Damage and death of both thalami

35
Q

Why does basilar artery stroke syndrome with a distal blockage give CN3 oculomotor nerve palsy?

A

Damage and death of midbrain where CN3 nuclei is located

36
Q

What is a lacunar artery stroke syndrome?

A

Signs and symptoms due to blockage of the lenticulostriate arteries which supply the internal capsule

37
Q

What are the signs and symptoms of a lacunar artery stroke syndrome?

A

Pure motor symptoms

-initial hypotonia, followed by hypertonia paralysis in whole contralateral side of body

38
Q

What does the thalamoperforator artery branch off?

A

The posterior cerebral artery

40
Q

What is a thalamoperforator artery stroke syndrome?

A

Signs and symptoms due to blockage of the thalamoperforator artery with supplies part of the thalamus

41
Q

What are the signs and symptoms of thalamoperforator artery stroke syndrome?

A

Pure sensory symptoms

-loss of all sensory modalities in whole contralateral side of body

42
Q

What investigations are done for a patient with a stroke?

A

Blood tests

CT head scan

43
Q

Why is a CT head scan done for a patient with a stroke?

A

To distinguish between an ischaemic stroke and a haemorrhagic stroke

44
Q

What does an ischaemic stroke look like on a CT head scan?

A

May appear normal

Hyperdense artery i.e. bright artery, due to it containing blood clot

Hypodense grey matter i.e. dark grey matter, due to it being ischaemic

45
Q

When is hypodense grey matter seen on a CT head scan of a patient with a stroke?

A

More than an hour after the stroke

46
Q

What do haemorrhagic strokes look like on a CT head scan?

A

Bright white areas

47
Q

How is a patient with a stroke treated?

A

Within 4.5 hours and no contraindications, thrombolysis

Aspirin after 2 days, continue for 14 days

Statins

Sem 4 - Nervous System (25 decks)

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