Session 10 - Lecture 1: Stroke

Question 1

Define a cerebrovascular accident.

Answer 1

Blood supply to part of the brain is cut off.

Question 2

Define a transient ischaemic attack.

Answer 2

Mini stroke, similar symptoms to a stoke but complete resolution within 24 hours as the blood supply is only partly occluded.

Question 3

What is the first line of investigation for a suspected acute stroke?

Answer 3

Urgent CT head

Question 4

What investigation would be appropriate for an ischaemic stroke?

Answer 4

Will not have any findings on CT so would have to conduct MRI scan of the head.

Question 5

Describe the route the internal carotid artery takes to supply the brain.

Answer 5

ICA –> carotid canal (petrous part of temporal bone) –> cavernous sinus –> 180 degrees turn –> circle of Willis –> anterior and middle cerebral artery.

Question 6

Describe the route the subclavian artery takes to supply to brain.

Answer 6

Subclavian artery –> vertebral artery (1st branch) –> through the transverse foramina of cervical vertebrae –> foramen magnum –> basilar artery.

Question 7

Describe the symptoms of an anterior cerebral artery infarct.

Answer 7

Unilateral contralateral weakness, leg/shoulder more so than arm/face as ACA is more medial. Sensory distribution is also similar. Urinary incontinence as the paracentral lobules are located medially as well, apraxia (inability to complete motor planning), dysarthria/aphasia (location of premotor cortex), corpus callosum involvement e.g. split brain, alien hand, etc.

Question 8

Describe the symptoms of a middle cerebral artery infarct.

Answer 8

High mortality rate (80%), gives rise to lenticulostriate arteries which supply the internal capsule and basal ganglia. Would get contralateral hemiparesis (more lateral homunculus), proximal infarct would include lenticulostriate arteries that supply internal capsule –> full hemiparesis, distal infarct spares the internal capsule so only the area of the homunculus supplied by MCA would be affected. Contralateral hemisensory loss, hemianopia (usually homonymous and non-macula sparing), aphasia (if main trunk infarct then both areas affected as Broca’s is frontal and Wernicke’s is temporo-parietal) and hemispheres-spatieal neglect (can see but cannot comprehend with non-dominant hemisphere infarction).

Question 9

Describe the symptoms of a posterior cerebral artery infarct.

Answer 9

Contralateral homonymous hemianopia with macula sparing.

Question 10

Describe the symptoms of a cerebellar artery infarct.

Answer 10

Non-specific symptoms e.g. nausea, vomiting, headache and dizziness. Will also get DANISH symptoms (ipsilateral), brainstem signs such as Horner’s syndrome and contralateral sensory deficit.

Question 11

Describe the symptoms of a basilar artery infarct.

Answer 11

Distal infarct = visual and oculomotor defects, behaviour change and hallucinations.
Proximal (up to pons) = locked in syndrome - complete loss of movement, preserved consciousness and ocular movements (often only vertical gaze).

Question 12

What are the requirements of a total anterior circulation stroke?

Answer 12

Require ALL three of:

• Unilateral weakness (+/- sensory deficit) of face, arm and leg
• Homonymous hemianopia
• Higher cerebral dysfunction

Question 13

What are the requirements of a partial anterior circulation stroke?

Answer 13

Requires TWO from:

• Unilateral weakness (+/- sensory deficit) of face, arm and leg
• Homonymous hemianopia
• Higher cerebral dysfunction

Question 14

What are the requirements of a posterior circulation stroke?

Answer 14

Requires ONE of the following:

• Cranial nerve palsy with contralateral motor/sensory deficit
• Bilateral motor/sensory deficit
• Conjugate eye movement disorder
• Isolated homonymous hemianopia with macular sparing

Question 15

What are the requirements for Lacunar syndrome?

Answer 15

Requires ONE of the following:

• Pure sensory deficit
• Pure motor deficit
• Sensory-motor deficit
• Ataxic hemiparesis