Clinical aspects of stroke

Question 1

What does middle cerebral artery supply?

Answer 1

supplies lateral hemisphere convexity and underlying cortex and wm

Question 2

what does porterior cerebral artery supply?

Answer 2

medial temporal occipital parietal lobe

Question 3

what do motor areas give rise to?

Answer 3

fibres that come down to coronradiata wmand converge interlal capsule

Question 4

what affect can an infarct have on the motor system and why/

Answer 4

infarct can cause extensive motor deficit (face,arm leg) because fibres are closely packed in the subcortical region

Question 5

what are clinical signs of ischaemic stroke due to total mca territory infraction

Answer 5

hemiparesis
drowsy
hemisensory loss
cortical signs - visual field loss, inattention, neglect

Question 6

what clinical signs do you see on small deep lacunar infarct (ischaemic stroke)

Answer 6

hemiparesis

normal conscious level and no cortical signs

Question 7

what clinical signs do you see on lower brainstem infarct (ischaemic stroke)

Answer 7

right tongue weakness
mild left hemiparesis
left sided sensory loss
no cortical signs

Question 8

what % is ischameic/haemorrhage

Answer 8

80% - ischaemic - loss of blood flow/blockage

20* haemorrhage - bleeding within brain –> 15% primary intracerebral, 5% subarachnoid

Question 9

What are mechanisms due to risk factors such as hypertension, alchohol, obesity etc. ?

Answer 9

small vessel occlusion or rupture
large artery-artery embolism
cardiac embolism
haemodynamic

Question 10

main causes of ischaemic stroke - embolism (clot goes from one place to another)

Answer 10

thrombus, atheramatous material, vegetations
from the heart (atrial fibrillation, valvular heart disease, myocardial infarction)
from the extracranial carotid or vertebrobasilar vessels (atheroma, dissection)

Question 11

main causes of ischaemic stroke - in situ thrombosis

Answer 11

small perforating vessel occlusion (lacunar)
large vessel occlusion
venous occlusion

Question 12

what are rare causes of ischaemic stroke

Answer 12

dissection
vasculitis and SLE
drug
migraine
meningitis
endocarditis
atrial myxoma
antiphospholipid syndrome
Fabry's disease
moya-moya

Question 13

what is seen on interal carotid artery dissection

Answer 13

rapid narrowing of lumen
crescent of blood in the vessel wall
small emboli in the carotid territory

Question 14

what are symptoms of acute intracerebral haemorrhage and what do you see on CT

Answer 14

bright on CT
drowsiness
headache
hypertension

Question 15

what are rare causes of intracranial haemorrhage

Answer 15

cerebral vasculitis
cerebral venous thrombosis
drug abuse
cerbral tumours

Question 16

what tests do you do to find why the stroke happened

Answer 16

bloods
cardiac test
neck vessel imaging

Question 17

what is the most important modifiable risk factor for primary and secondary prevention

Answer 17

hypertension

Question 18

what is the treatment of acute stroke

Answer 18

drug therapy -->
thrombolysis within 3 hours
aspirin for ischaemic stroke (48 hours)
stroke unit care -->
maintain normal physiology
prevent/treat complications
rehabilitation

Question 19

what can thrombolysis for ishaemic stroke do?

Answer 19

in blocked vessel, blood flow goes down to 10ml and infarct can’t salvage
penumber is 10-20ml
surviving > 20ml
Alteplase (rtPA) treatment, improves recovery if given within 4.5 hours

Question 20

what are limitations of IV thrombolysis alone?

Answer 20

not good at restoring flow
narrow therapeutic time window
contraindications such as recent surgery, coagulation abnormalities, history of intracranial haemorrhage

Question 21

What can you do apart from thrombolysis

Answer 21

thrombectomy