Lecture 11 - Stroke Syndromes

Question 1

What are the four types of intracranial haemorrhages?

Answer 1

1. Epidural hematoma (EDH)
2. Subdural hematoma (SDH)
3. Subarachnoid haemorrhage (SAH)
4. Intracerebral or intraparenchymal haemorrhage (ICH)

Question 2

Describe subdural haematoma

Answer 2

• bleeding between dura and arachnoid
• usually due to rupture of vein - so more slow etc
  this is more common with age
• can be chronic, usually in elderly, where their brain is atrophied with age, so more space for blood
• can be acute - associated with severe injuries - worse outcome than chronic, but will be fine if you deal with it quickly.

Question 3

describe subarachnoid haemorrhage

Answer 3

• between arachnoid and pia

- nontraumatic and traumatic

Question 4

Describe a nontraumatic/spontaneous subarachnoid haemorrhage

Answer 4

“worst headache of my life”
- usually caused by the rupture of an arterial aneurysm in the subarachnoid space
- also could be called by AVM
-

Question 5

What are berry aneurysms

Answer 5

aneurysms that look like a berry.

usually arise around the circle of willis, particularly at the bifurcations

Question 6

What is an aneurysm

Answer 6

Balloon-like outpouchings of the vessel wall that usually have a neck connecting it to the vessel.

-usually arises in the anterior circulation (carotid arteries and its branches)

Question 7

What puts people at risk of aneurysm rupture?

Answer 7

• hypertension
• smoking
• alcohol
• situations causing sudden elevated bp - eg exercise

Question 8

Describe traumatic subarachnoid haemorrhage

Answer 8

Caused by bleeding vessel into the subarachnoid space, due to traumatic injury or contusion

Question 9

Descrive AVM

Answer 9

Ateriovenous malformation

• important cause for nontraumatic intracerebral haemorrhage
• congenital abnormalities where there are abnormal direct connections between arteries and veins forming a tangle of blood vessels
• best seen on cerebral angiography
• can also cause seizures, migrianes.
• usually removed if affects functioning and behaviour eg. language.

Question 10

describe intracerebral haemorrhage

Answer 10

aka intraparenchymal

• within the brain hmispheres, brainstem, cerebellum or spinal cord
• traumatic - contusions can cause bleeding in white matter
• non traumatic - hypertension, brain tumors, secondary haemorrhage after ischaemic infarction, AVM, etc.

these are more commonly the cause of stroke syndromse

Question 11

name the order of the homonculusf from bottom of frontal lobe up

Answer 11

face - hand - arm - trunk - leg - foot

Question 12

Difference between ischaemic and haemorrhage

Answer 12

ischaemic - blockage

haemorrhagic - explosion of blood

Question 13

how does the PCA affect memory?

Answer 13

it supplies to the hippocampus, parahippocampal gyrus, mammilary body and mammilothalamic tract, and thalamus.

• usually need bilateral

– L – verbal amnesia; colour, object agnosia
– R – visuospatial, faces, locations, navigation

Question 14

Describe a thalamic stroke

Answer 14

– Memory loss +
• Wide range of neuropsychological features – Arousal
– Attention
– Motivation
– Initiative
– Executive function

Question 15

what is the visual syndrome of PCA infarct

Answer 15

anton-babinski syndrome - visual anosognia - cortically blind but think they can see

.. sometihng about lacunae infarcts

Question 16

Balint’s syndrome?

Answer 16

clinical triad:
- optic ataxia - cant reach for objects, but can see and recognise them. movement problem

• psychic paralysis of gaze - can’t visual scan or maintain fixation on object - eyes wander
• simultanagnosia - not able to perceive more than one object at time.

due to BILATERAL OCCIPITAL-PARIETAL LESIONS

Question 17

What is collateral circulation

Answer 17

if you compromise one vessel, benefit of the circuit of willis is that all of the surrounding vessels can cope by…getting around somehow…