stroke

Question 1

define stroke

Answer 1

serious life threatening condition that occurs when blood supply to brain is cut off and symptoms last longer than 24 hours

Question 2

define TIA

Answer 2

min strokes but symptoms reverse within in 24 hours

Question 3

what is the cause of Heamorrhagic stroke ?

Answer 3

Intracerebral (rupture of a vessel in brain parenchyma)

 Subarachnoid

Question 4

what is another cause of stroke other than Ischaemia or haemorrhaigc ?

Answer 4

Dissection (separation of walls of artery, can occlude branches)
 Venous sinus thrombosis (occlusion of veins causes
backpressure and ischaemia due to reduced blood flow)
 Hypoxic brain injury (e.g. post cardiac arrest)

Question 5

what is the 2 things you do when suspected stroke comes in ?

Answer 5

check if <4 hours = thombolysis

CT scan

Question 6

why CT scan ?

Answer 6

rule out haemorrhagic cause . you cant see anything on CT if acute ischaemia . only established infracts show on CT

Question 7

what can you do for suspected Ischaemic stroke?

Answer 7

MRI- high signal area

Question 8

what would you see in Anterior cerebral artery infract ?

Answer 8

Contralateral weakness in lower limb/ sensory

 Lower limb affected much worse than upper limb and face due to motor homonculus

Question 9

how can you tell the paracentral lobe when affected ?

Answer 9

Urinary incontinence is present

Question 10

how can you tell left frontal/ inferior parietal lobe is affected ?

Answer 10

Apraxia- Inability to complete motor planning

Question 11

what supplies the corpus callosum ? if there is pathology what can it lead to ?

Answer 11

anterior cerebral artery

Split brain syndrome / alien hand syndrome

Question 12

what happens in frontal lobe damage in stroke ?

Answer 12

Dysarthria / aphasia

Question 13

what is a complication of MCA infarcts?

Answer 13

haemorrhagic transformation - vessels in the

infarcted area break down

Question 14

what do you see in MCA infarcts?

Answer 14

full contralateral hemiparesis

Visual field defects- contralateral homonymous
hemianopia without macular sparing

Aphasia

Question 15

how can you tell if Lacunar stroke or Trunk MCA infarct?

Answer 15

lacunar = higher cortical function is not affected

Question 16

where would you see sensory loss on MCA infarcts?

Answer 16

o Contralateral -face
and arm, but could involve larger areas if
sensory fibres in internal capsule affected

Question 17

why is there visual fields defects in MCA infarcts ?

what happens if more distal ?

Answer 17

estruction of both superior
and inferior optic radiations

one radiation affected causing
quadrantanopias

Question 18

what kind of aphasia in superior MCA infarct? also what limbs are mostly affected ?

Answer 18

Broca’s due to frontal lobe supply - dominant only
contralateral
face and arm weakness

Question 19

what kind of aphasia in inferior MCA infarct?

what also is affected as well?

Answer 19

Wernicke's (receptive)
contralateral
sensory change in face and arm
 optic
radiations- visual defects

Question 20

when would you see global aphasia ?

Answer 20

MCA trunk infarcts

Question 21

why do you get Contralateral neglect ? what other symptoms may occur with it

Answer 21

lesions of right parietal lobe (non dominant)

Tactile extinction
Visual extinction
Anosognosia

Question 22

what is the Essential distinguishing feature of a lacunar stroke ?

Answer 22

sub cortical symptoms not cortical e.g. neglect or aphasia

Question 23

what do you PCA infarcts ? why do you see these signs ?

Answer 23

Contralateral homonymous hemianopia (with macular
sparing due to collateral supply from MCA)
• Contralateral sensory loss due to damage to thalamus

Question 24

what side will you see cerebellar signs compared to its lesion ?

Answer 24

ipsilateral

Question 25

what are the signs for cerebellar infarcts

Answer 25

``` Nausea • Vomiting • Headache • Vertigo / dizziness DANISH ```

Question 26

why can you see contralateral sensory deficit / ipsilateral Horner’s in cerebellar infarcts ?

Answer 26

brainstem involvement

Question 27

what symptoms do you see in brainstem infarcts ? | why do you see these ?

Answer 27

``` contralateral limb weakness is seen with ipsilateral cranial nerve signs- damage to corticospinal tracts (above decussation of pyramids) and damage to cranial nerve nuclei on same side ```

Question 28

what can you see in superior/distil basilar infarcts ?

Answer 28

Visual and oculomotor deficits - (supplies oculomotor nuclei ) Behavioural abnormalities • Somnolence, hallucinations and dreamlike behaviour motor dysfunction absent often

Question 29

what can you see in inferior/proximal basilar infarcts ?

Answer 29

locked in syndrome • Complete loss of movement of limbs- can move eyes Preserved consciousness

Question 30

why is there vertical eye movement in inferior basilar infarcts ?

Answer 30

midbrain is getting supply from PCAs via posterior communicating arteries

Question 31

using Bamford oxford , how can classify TACS?

Answer 31

all 3 of : unilateral weakness (and/or sensory deficit) of the face, arm and leg Homonymous hemianopia Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 32

using Bamford oxford , how can classify PACS?

Answer 32

Two of the following " Unilateral weakness (and/or sensory deficit) of the face, arm and leg Homonymous hemianopia Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 33

using Bamford oxford , how can you classify POCS?

Answer 33

One of: Cranial nerve palsy and a contralateral motor/sensory deficit Bilateral motor/sensory deficit Conjugate eye movement disorder (e.g. horizontal gaze palsy) Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia) Isolated homonymous hemianopia

Question 34

using Bamford oxford , how can you classify LACS?

Answer 34

``` One of : Pure sensory stroke Pure motor stroke Senori-motor stroke Ataxic hemiparesis ```