C: Brain imaging

Question 1

What kind of imaging is used in strokes and why?

Answer 1

Usually CT due to higher availability and speed

Done to exclude haemorrhage and prove ischaemic stroke

Question 2

What is a lacunar stroke?

Answer 2

Stroke which affects a smaller area - hand and arm affected rather than full hemiparesis

Question 3

What are the 6 symptoms of cerebellar infract, are they ipsilateral or contralateral? (DANISH)

Answer 3

1) Dysdiadokinesis
2) Ataxia - loss of control of bodily movements
3) Nystagmus
4) Intention tremor
5) Slurred speech
6) Hypotonia - low muscle tone

Question 4

What would be the main symptoms of a large right sided infarct due to MCA blockage? 4

Answer 4

1) Aphasia - loss of speech
2) Inattention - right side to do with spatial awareness
3) Left sided hemiparesis and hemiarthresia
4) L homogenous hemianopia - loss of left visual field

Question 5

What would be the clinical presentation of a left cerebellar infarct? 2

Answer 5

1) Inattention

2) Incoordination

Question 6

If a patient has a internal carotid artery blockage what is the likely prognosis and GCS score?

Answer 6

Very low GCS score

Death is highly likely

Question 7

What are 2 risk factors for bleeding in the basal ganglia region?

Answer 7

1) Anti coagulants eg. warfarin

2) Bleeding disorders

Question 8

What 3 symptoms does a subarachnoid haemorrhage present with?

Answer 8

1) Thunderclap headache - horrendous headache, blood irritates the meninges
2) Vomiting
3) Low GCS

Question 9

What artery is commonly ruptures in extradural haemorrhage?

Answer 9

Middle meningeal artery

Question 10

How is an extradural haemorrhage treated?

Answer 10

With burr hole surgery

Question 11

What is the common clinical presentation of an extradural haemorrhage?

Answer 11

Trauma followed by a lucid interval (temporary improvement in patients condition) followed by a loss of conciousness

Question 12

What is a contre-coup injury?

Answer 12

Get soft tissue injury on one side, hit to that side causes brain to hit opposite side of skull and get bleed on other side of the brain

Question 13

Subdural haemorrhage is usually caused by what?

Answer 13

Tearing of bridging veins which cross the subdural space

Question 14

How does a subdural haemorrhage present?

Answer 14

Gradual increase in headache and confusion

Question 15

Give 3 risk factors for subdural haemorrhage?

Answer 15

1) Elderly
2) Traumatic
3) Alcoholics

Question 16

If a patient presented with changes in personality and disinhibition, where is the lesion most likely to be?

Answer 16

In the frontal cortex

Question 17

Infarction of the midbrain would cause what syndrome?

Answer 17

Locked in syndrome

Question 18

Why is vision and hearing unaffected in a midbrain infarct?

Answer 18

Because CN1 and CN2 come off the brain above the brainstem

Question 19

A right occipital infarct would cause what syndrome?

Answer 19

Charles Bonnay syndrome - left homonymous hemianopia (primary visual cortex is in the occipital lobe)