Stroke

Question 1

define a stroke

Answer 1

focal neurological deficit that causes a vascular deficit and lasts longer than 24 hours

Question 2

what parts of the brain does the anterior cerebral artery supply

Answer 2

superior and medial aspects of the cerebrum

Question 3

what parts of the brain does the middle cerebral artery supply

Answer 3

majority of the lateral aspect of the cerebrum

Question 4

what parts of the brain does the posterior cerebral artery supply

Answer 4

occipital lobe

Question 5

if there is occlusion of the anterior cerebral artery, what clinical features occur

Answer 5

contralateral weakness and sensory loss to the leg
loss of bladder control
visual disturbance

Question 6

if there is occlusion of the middle cerebral artery, what clinical features occur

Answer 6

contralateral weakness and sensory loss to the arm and face
homonymous hemianopia
visuospatial problems

Question 7

if the middle cerebral artery is occluded on the dominant side, what additional features are seen

Answer 7

aphasia

apraxia

Question 8

what is Wernickes aphasia

Answer 8

the ability to understand words and sentences is impaired but the ability to speak is not
therefore the speech is fluent but non-sensical

Question 9

where is Wernicke’s area located

Answer 9

temporal lobe

Question 10

what is Broca’s aphasia

Answer 10

the ability to produce speech is impaired but comprehension of language is not
therefore speech is laboured but makes sense

Question 11

where is Broca’s area located

Answer 11

frontal lobe

Question 12

if the posterior cerebral artery is occluded, what clinical features are seen

Answer 12

macular sparing homonymous hemianopia

Question 13

what are the 2 types of stroke that can occur

Answer 13

ischaemic

haemorrhagic

Question 14

outline the pathophysiology of ischaemic stroke

Answer 14

due to cerebral occlusion causing infarction

either thrombotic or embolic in origin causing occlusion of cerebral vessels and area of the brain is damaged

Question 15

what is a thrombotic event causing a stroke

Answer 15

blockage of vessel at the site of occlusion

develops due to atherosclerosis of vessels

Question 16

what is an embolic event causing a stroke

Answer 16

clots arise distally, break off from the site of origin and travel up to the brain via the internal carotids
usually due to previous MI, AF or endocarditis

Question 17

what causes an haemorrhagic stroke to occur

Answer 17

develops as a result of intercerebral haemorrhage which reduces the blood supply to other parts of the brain

Question 18

what is the main risk factor for developing haemorrhagic stroke

Answer 18

uncontrolled hypertension

Question 19

which type of stroke is most common

Answer 19

ischaemic 80% of all strokes

Question 20

outline the main modifiable risk factors for having a stroke

Answer 20

hypertension
diabetes 
smoking
increased clotting
heart disease - AF, ischaemic, valvular

Question 21

what areas of the brain are affected in a total anterior circulation stroke

Answer 21

blockage of both anterior and middle cerebral arteries

Question 22

for a diagnosis of TACS what 3 features must be present

Answer 22

unilateral weakness of face, arm and leg
homonymous hemianopia
higher cerebral dysfunction - dysphasia and visuospatial problems

Question 23

what areas of the brain are affected in a partial anterior circulation stroke

Answer 23

smaller than TACS, blockage of one of anterior or middle cerebral artery

Question 24

for diagnosis of PACS what features must be present

Answer 24

2 of the following
unilateral weakness of face, arm and leg
homonymous hemianopia
higher cerebral dysfunction - dysphasia and visuospatial problems

Question 25

what areas of the brain are affected in posterior circulation syndrome

Answer 25

damage to the areas supplied by posterior cerebral artery - vertebral and basilar arteries

Question 26

for diagnosis of POCS, what features must be present

Answer 26

one of the following present isolated homonymous hemianopia cerebellar/brainstem syndrome - ataxia, nystagmus and diplopia +/- confusion and mood changes

Question 27

what causes a lacunar stroke to develop

Answer 27

due to multiple small vessel infarcts in basal ganglia and thalamus, it is a subcortical stroke therefore higher cerebral functions are preserved

Question 28

what features are present in a lacunar stroke

Answer 28

one of the following purely sensory stroke ataxic hemiparesis unilateral weakness +/- sensory symptoms in face, arms and legs

Question 29

what causes a stroke from a carotid artery dissection to occur

Answer 29

spontaneously | whiplash trauma

Question 30

how does a stroke from carotid artery dissection present

Answer 30

focal neuro deficits pain in neck/face Horner's syndrome lower cranial nerve symptoms

Question 31

what is the first line investigation for someone presenting with symptoms of a stroke

Answer 31

CT brain if presenting acutely | MRI if presenting several days after the onset of symptoms

Question 32

what is the immediate findings of an ischaemic stroke on CT

Answer 32

hyperdense segment representing intravascular thrombus/embolism - most commonly seen within the MCA

Question 33

after the first few hours of a stroke what findings develop

Answer 33

loss of grey-white matter differentiation

Question 34

what are the CT features of a chronic stroke

Answer 34

swelling reduces and gliosis begins to set in, very dense region around the area of infarction which causes a negative mass effect

Question 35

what is the first line management of acute stroke

Answer 35

ABCDE establish whether the stroke is ischaemic or haemorrhagic monitor glucose and ensure adequate hydration

Question 36

if an ischaemic stroke is detected within 4.5 hours of first presentation, how is it managed

Answer 36

thrombyolsis

Question 37

what are the 2 agents that can be used for thrombolysis

Answer 37

IV altepase and tissue plasminogen activator

Question 38

list some contraindications to thrombolysis

Answer 38

``` seizures recent surgery major infarct haemorrhagic stroke currently on anti-coags ischaemic stroke in last 3 months ```

Question 39

if a patient presents after 4.5 hours of symptoms thrombolysis is ineffective true/false

Answer 39

true

Question 40

how is a stroke managed after presenting after 4.5 hours

Answer 40

aspirin 300mg

Question 41

following an ischaemic stroke, what secondary prevention measures must be in place

Answer 41

ABC - anti-platelets, blood pressure medication and cholesterol control

Question 42

after a stroke, what medication is commenced irrespective of the extent of patient risk factor

Answer 42

statins and anti-platelets | whereas anti-hypertensives only commenced if clinical hypertension