Stroke

Question 1

Define stroke

Answer 1

A serious life threatening condition that occurs when the blood supply to part of the brain is cut off

Question 2

Define transient ischaemic attack

Answer 2

Similar clinical features of stroke but resolve within 24 hours

Question 3

Different between stroke and TIA

Answer 3

Similar clinical features but TIA < 24 hours

Question 4

Types of stroke

Answer 4

• ischaemic: thromboembolic
• haemorrhagic: intracerebral + subarachnoid
• other: dissection, venous sinus thrombosis, hypoxic brain injury

Question 5

Emergency management of stroke

Answer 5

• are they within the window for thrombolysis (<4 hours)?
• CT head to determine if bleed

Question 6

Imaging of stroke

Answer 6

CT head
MRI

Question 7

Stroke symptoms of anterior cerebral artery infarction

Answer 7

• contralateral weakness in lower limb (supplies medial homonculus)
• contralateral sensory changes in same pattern as motor deficits
• urinary incontinence
• apraxia
• dysarthria/aphasia
• split brain syndrome/alien hand syndrome

Question 8

What is apraxia?

Answer 8

Inability to complete normal day to day motor tasks
e.g. difficulty dressing oneself (buttons) even when power is normal

Question 9

Why can anterior cerebral artery infarction cause urinary incontinence?

Answer 9

Paracentral lobule affected
Controls motor + sensory innervations to contralateral lower extremity > responsible for control of urination + defecations

Question 10

Main points of occulsion of the middle cerebral artery

Answer 10

• Main stem (proximal)
• Lenticulostriate arteries
• Cortical branches
• Inferior division
• Superior division

Question 11

Stroke symptoms due to proximal middle cerebral artery infarct

Answer 11

• contralateral hemiparesis of face, arm + leg
• contralateral sensory loss
• contralateral homonymous hemianopia without macular sparing
• global aphasia (broca’s + wenicke’s) if left sided
• right sided neglect if right sided

Question 12

What is alien hand syndrome?

Answer 12

A phenomenon in which one hand is not under control of the mind /hand acts as if it has a mind of its own

Question 13

Types of stroke symptoms due to lenticulostriate arteries infarct (lacunar infarct)

Answer 13

• neglect, aphasia + visual field defects not present
• pure motor stroke: face, arm + legs weakness
• pure sensory stroke face, arm + legs sensory loss/change
• sensorimotor stroke: mixture of both

Question 14

Difference between lacunar infarct + proximal middle cerebral artery infarct symptoms

Answer 14

Neglect, aphasia + visual field defect absent in lacunar infarct

Question 15

Stroke symptoms of inferior division of middle cerebral artery infarct

Answer 15

• inferior division supplies lateral parietal + superior temporal lobe
• contralateral sensory change in face + arms
• receptive/Wernicke’s aphasia if left sided
• homonymous hemianopia

Question 16

What artery is most common affected in strokes?

Answer 16

Middle cerebral artery

Question 17

What does the inferior division of middle cerebral artery supply?

Answer 17

Lateral parietal - primary sensory cortex
Superior temporal lobe - Wenicke’s area

Question 18

What does the superior division of the middle cerebral artery supply?

Answer 18

Lateral frontal lobe - Broca’s area

Question 19

Stroke symptoms due to superior division of middle cerebral artery infarct

Answer 19

• contralateral face + arm weakness
• expressive/Broca’s aphasia if left sided

Question 20

Stroke symptoms due to posterior cerebral artery infarct

Answer 20

• contralateral homonymous hemianopia with macular sparing
• contralateral sensory loss/change due to involvement of thalamoperforator/thalamogeniculate branches

Question 21

Symptoms + signs of cerebellar strokes

Answer 21

• N + V
• vertigo/dizziness
• headache
• ipsilateral cerebellar signs DANISH
• ipsilateral cranial nerve signs
• contralateral sensory deficit
• ipsilateral Horner’s syndrome

Question 22

What supplies the internal capsule?

Answer 22

Lenticulostriate arteries

Question 23

What is neglect?

Answer 23

Failure to acknowledge the existence of the left side of space, objects + their own body

Question 24

Signs of neglect

Answer 24

Tactile + visual extinction
Anosognosia/lack of insight

Question 25

Why can a basilar artery occulsion cause sudden death?

Answer 25

Supplies brainstem which contains many vital centres

Question 26

Presentation of distal (superior) basilar artery infract

Answer 26

• visual + oculomotor deficits
• behavioural abnormalities
• hallucinations, somnolence + dreamlike behaviour

Question 27

Why is motor dysfunction usually absent in basilar artery occlusion?

Answer 27

Cerebral peduncles ‘rescued’ by posterior communicating artery

Question 28

Presentation of proximal (at level of pontine branches) basilar artery infract

Answer 28

• locked in syndrome
• complete loss of movement of limbs
• preserved ocular movement due to Pcomm supply
• preserved consciousness

Question 29

What is used to classify strokes?

Answer 29

Bamford (oxford) stroke classification

Question 30

Presentation of brainstem strokes

Answer 30

Ipsilateral brainstem signs
Contralateral motor + sensory deficits

Question 31

What cranial nerve is at risk in a posterior communicating artery aneurysm?

Answer 31

Oculomotor
Runs parallel

Question 32

What is anosogonsia?

Answer 32

Condition in which a patients is unaware of their neurological deficit or psychiatric condition
Lack of insight