Stroke

Question 1

What are the 2 main types of stroke?

Answer 1

Ischaemic
haemorrhagic

Question 2

What is an ischaemic stroke?

Answer 2

where a blocked artery reduces blood flow to the brain
this is a sudden and complete blockage

Question 3

What is a haemorrhagic stroke?

Answer 3

where an artery in the brain is damaged and leaks, creating a bleed in the brain

Question 4

What is a TIA?

Answer 4

transient ischaemic attack
this is where ischaemic damage in the brain causes stroke-like symptoms that self-resolve within 24 hours

Question 5

Name the 4 lobes of the cerebral cortex

Answer 5

frontal
parietal
temporal
occipital

Question 6

What is meant by the term lateralisation?

Answer 6

each hemisphere of the brain controls the opposite (contralateral) side of the body

Question 7

Summarise the function of the frontal lobe

Answer 7

controls movement and executive function (ability to make decisions)

Question 8

Summarise the function of the parietal lobe

Answer 8

Processes sensory information and therefore controls proprioception

Question 9

Summarise the function of the temporal lobe

Answer 9

Has roles in hearing, memory, smell, language and facial recognition

Question 10

Summarise the function of the occipital lobe

Answer 10

primarily responsible for vision

Question 11

List the 4 main arteries that form blood supply to the brain

Answer 11

L and R internal carotid arteries
L and R vertebral arteries

Question 12

What do the L and R vertebral arteries join together to form?

Answer 12

the basilar artery

Question 13

What do the internal carotid arteries turn into?

Answer 13

middle cerebral arteries

Question 14

What is supplied by the middle cerebral arteries?

Answer 14

lateral portions of frontal, parietal and temporal lobes

Question 15

What branches off the internal carotid arteries?

Answer 15

anterior cerebral arteries
posterior communicating arteries

Question 16

What is supplied by the anterior cerebral arteries?

Answer 16

medial portion of frontal and parietal lobes

Question 17

What connects the two anterior cerebral arteries?

Answer 17

the anterior communicating artery

Question 18

What do branches of the vertebral and basilar arteries supply?

Answer 18

cerebellum
brain stem

Question 19

What does the basilar artery divide into?

Answer 19

posterior cerebral arteries

Question 20

What is supplied by the posterior cerebral arteries

Answer 20

occipital lobe, some of the temporal lobe, thalamus

Question 21

What is the name for how the blood supply to the brain all links together?

Answer 21

all the vessels are linked via the circle of Willis

Question 22

Give an advantage of the circle of Willis

Answer 22

this offers alternative ways for blood to supply the brain, in the case of obstructions

Question 23

What are the two mechanisms for how ischaemic strokes can happen?

Answer 23

endothelial cell dysfunction
embolism

Question 24

Summarise the endothelial cell dysfunction mechanism of strokes

Answer 24

this is where something irritates the tunica intima, such as tobacco products
this leads to atherosclerosis

Question 25

What are the two components of plaque?

Answer 25

soft, cheesy-textured interior hard, fibrous cap

Question 26

What are the most common sites for atherosclerosis in the brain?

Answer 26

branch points particularly of the internal carotids and middle cerebral arteries

Question 27

Summarise the embolism mechanism of strokes

Answer 27

this is where a blood clot breaks off from one location and gets lodged in a vessel in the brain

Question 28

What blood vessels are affected in a lacunar stroke?

Answer 28

deep branches of middle cerebral artery

Question 29

What happens to the damaged brain tissue in lacunar strokes?

Answer 29

cysts form that look like lakes - hence the name 'lacunar'

Question 30

Name the main risk factors for an ischaemic stroke

Answer 30

smoking atherosclerosis hypertension diabetes high cholesterol

Question 31

What is the ischaemic core?

Answer 31

this is tissue that dies in the stroke

Question 32

What is the ischaemic penumbra?

Answer 32

this is tissue that is preserved by collateral circulation, that may survive if blood flow is restored quickly enough

Question 33

What builds up in cells when there are low glucose and oxygen levels?

Answer 33

sodium calcium

Question 34

What is the consequence of high sodium levels in cells?

Answer 34

this draws water into the cell this causes cytotoxic oedema, where the cell swells up

Question 35

What is the consequence of high calcium levels in cells?

Answer 35

this causes build up of reactive oxygen species, that leads to release of apoptosis inducing factors and degradative enzymes

Question 36

What is vasogenic oedema?

Answer 36

this is where fluids and proteins get into brain tissue, due to damage to the blood-brain barrier, caused by inflammation

Question 37

Where is Broca's area located?

Answer 37

left frontal lobe

Question 38

Where is Wernicke's area located?

Answer 38

left temporal lobe

Question 39

What symptoms would you expect to see in an anterior or middle cerebral artery stroke?

Answer 39

numbness sudden muscle weakness

Question 40

What main symptom would you expect to see in a posterior cerebral artery stroke?

Answer 40

vision changes

Question 41

What does the FAST acronym mean?

Answer 41

facial drooping arm weakness speech difficulties time

Question 42

How can a stroke be diagnosed with imaging?

Answer 42

CT/MRI scans angiography

Question 43

What is the management for ischaemic strokes?

Answer 43

reestablishment of blood flow via thrombolytic enzymes and aspirin or surgical intervention in severe cases

Question 44

Name two surgeries that could be done to help restore blood flow in arteries

Answer 44

carotid endarterectomy placement of a stent

Question 45

What signs are seen in a lacunar stroke?

Answer 45

motor and/or sensory deficits only

Question 46

What signs are seen in a PAC stroke?

Answer 46

PAC = partial anterior circulation 2 of the following signs are present: - motor or sensory deficits - cortical deficits - hemianopia

Question 47

What signs are seen in a TAC stroke?

Answer 47

TAC = total anterior circulation all of the following signs are present: - motor or sensory deficits - cortical deficits - hemianopia

Question 48

What signs are seen in a posterior circulation stroke?

Answer 48

hemianopia brain stem dysfunction cerebellar dysfunction