9.1: Strokes Flashcards
(21 cards)
Are most stroke haemorrhagic or ischaemic?
85% ischaemic
10% haemorrhagic
What does the anterior cerebral artery supply?
Medial portion of the frontal and parietal lobes and corpus callosum
If the left ACA was affected by a stroke, what symptoms would this cause?
Sensory and motor cortexes affected
Lower limb part of homonculus affected
Hence right hand sided sensory and motor loss
Also incontinence (as this is the most medial part of the homonculus)
Corpus callosum affected
Hence split brain syndrome and alien hand syndrome
What areas of the brain does the middle cerebral artery supply?
Lateral aspect of frontal and parietal lobes and internal capsule
Hence supplies upper limb and face part of homonculus
How would a patient with a stroke affecting the middle cerebral artery present?
Symptoms on left hand side
Upper limb and face sensory and motor loss (as this part of homonculus is affected)
If dominant hemisphere is affected: can cause Wernicke’s and Broca’s aphasia
If non dominant hemisphere affected: neglect
If internal capsule if affected, motor fibres to leg could also be affected
Proximal occlusion of MCA will lead to contralateral homonymous hemianopia (like a lesion at the optic tract)
What areas of the brain does the posterior cerebral artery supply?
Occipital lobe
Contains visual cortex
What symptoms will a posterior cerebral artery present with?
Occipital lobe affected
Hence visual cortex affected
So px would present with contralateral homonymous hemianopia but with macula sparing (due to MCA supply)
What symptoms will a patient with a stroke affecting one of the cerebellar artery present with?
All symptoms are ipsilateral!
DANISH
= dysdiadochokinesia, ataxia, nystagmus, intention tremor, slurred speech, hypotonia
Cerebellar arteries also supply brainstem! So proximal occlusion could cause brainstem symptoms too
Brain steam signs could be caused by a stroke affecting one of which arteries?
Cerebellar arteries (proximally, if distal it will cause cerebellar signs only)
How would brain steam signs present in a stroke affecting the left hand side of the brain stem.
Crossed deficit
Would affect left hand cranial nerve nuclei so ptosis on left hand side
But would could motor signs on contalateral right hand side of the body as the tracts would dessucate
How would stroke affecting the lenticulostriate arteries present?
Pure motor stroke due to affected internal capsule
Which part of the brain is affected to cause a pure sensory stroke?
Thalamus
Will be contralateral symptoms
What is the preferred method of imagine for a stroke?
CT
What are some key differentials for a stroke?
HEMI
= hypoglycaemia, epilepsy, migraines, infection
What dosage of aspirin is administered if an ischaemic stroke has been confirmed?
300mg
A px has suffered a stroke leading to weakness of the face and upper limb but no other clinical features. Which vessel is occluded?
A lenticulostriate artery in the internal capsule
This has caused a pure motor stroke
Blockage of the basilar artery can lead to which syndrome?
Locked in syndrome
A px has a homonymous inferiority quadrantanopia. Which lobe has been damaged?
Parietal lobe
(Inferior quadranatanopias occur due to damage to the superior optic radiations which run in the parietal lobe. Temporal lobe lesions can cause superior quadrantanopia as the superior optic radiations will have been damaged)
Following occlusion of the anteriiir cerebral artery a px develops RICP and herniates part of their cerebral cortex. Which part of the cerebral cortex is particularly vulnerable?
Cingulate cortex
Can herniate beneath the falx
A px presents with a right homonomous hemianopia with macular sparing and sensory deficit affecting all of the right side. Which vessel is likely to have been occluded?
LEFT posterior cerebral artery
Supplies the visual cortex and the thalamus
Occlusion of the proximal portion of the superior cerebellar artery may lead to damage to which other structure?
Midbrain
Superior cerebellar artery supplies the midbrain on its way to the cerebellum
