Stroke

Question 1

Stroke Definition

Answer 1

a clinical syndrome characterised by an acute loss of focal brain function that lasts more than 24 hours or leads to death

Question 2

TIA Definition

Answer 2

a clinical syndrome characterised by an acute loss of focal brain function causing minimal tissue injury that lasts less than 24 hours

Question 3

Haemorrhagic Stroke - causes

Answer 3

• arterial disease
• raised blood pressure
• bleeding diathesis
• haemorrhagic transformation of an infarct
  BLEED

Question 4

Ischaemic Stroke - causes

Answer 4

• large artery thromboembolism
• small artery disease
• embolism from the heart
• non atheromatous arterial disease
• blood disease
  BLOCKAGE
  more common

Question 5

Stroke risk factors

Answer 5

• previous TIA/stroke
• diabetes
• atrial fibrillation
• hypertension
• smoking
• drug abuse
• valvular heart disease
• carotid stenosis

Question 6

TOTAL ANTERIOR CIRCULATION SYNDROME

Answer 6

• hemiparesis with or without a sensory deficit involving at least 2 of 3 body areas
• homonymous visual field deficit
• higher cerebral/cortical dysfunction - dysphasia, neglect, visuospatial perceptual issues

Causes -

• infarct affecting MCA or ACA
• infarct affecting basal ganglia, cerebral cortex, internal capsule

Question 7

PARTIAL ANTERIOR CIRCULATION SYNDROME

Answer 7

only 2 of 3 TACS components

• homonymous visual field deficit
• isolated higher cortical dysfunction
• motor/sensory deficit restricted to one body area

Causes -
- occlusion or damage to the MCA or ACA

Question 8

LACUNAR SYNDROME

Answer 8

4 main types (never any cognitive or brainstem involvement)

• pure hemi motor loss in isolated body areas
• pure hemi sensory loss
• sensory (visual) or motor loss in isolated body areas with no other symptoms
• ataxis hemiparesis

Causes

• bleed or infarct in once of the small, deep penetrating arteries
• basal ganglia infarct

Question 9

POSTERIOR CIRCULATION SYNDROME

Answer 9

signs of dysfunction of the brainstem, cerebellum, thalamus and/or occipital lobe

Question 10

Possible Stroke Symptoms

Answer 10

MOTOR

• hemiparesis
• simultaneous bilateral weakness (rare)
• poor balance
• dysphagia

SPEECH

• receptive or expressive dysphasia
• dyslexia
• dysarthria

SENSORY

• hemisensory loss
• sensory inattention
• atereognosis

VISUAL

• monocular blindness
• hemianopia
• quadrantopia
• diplopia
• bilateral blindness

VESTIBULAR

• vertigo
• loss of equilibirum

MOTOR PLANNING
- apraxia

BEHAVIOURAL
- attention, memory, visuospatial

NON-FOCAL

• generalised weakness/sensory loss
• light headedness
• faintness
• confusion
• incontinence

Question 11

Middle Cerebral Artery

Answer 11

Supplies the lateral cerebral cortex of all lobes 
Symptoms 
R
- L hemiplegia 
- L sensory loss
- L hemianopia/quadrantopia 
- visuospatial neglect/inattention 
- motor impersistence 
- impulsivity 
- disinterest/poor motivation 
- anasognosia 
- autopagnosia 
- dyspraxia 
- astereognosis 
- verticality problems 
- dysarthria 
more likely to have perceptual/visuospatial issues 

L 
- R hemiplegia 
- R sensory loss 
- R hemianopia/quadrantopia 
- dysphagia 
- dysarthria 
- dyslexia 
- dyscalculia 
- dyspraxia 
more likely to be affected by dyspraxia and communication issues

Question 12

Anterior Cerebral Artery

Answer 12

Supplies

• medial frontal and parietal lobes
• olfactory tract
• anterior hypothalamus
• caudate nucleus and putamen
• internal capsule

Symptoms

• contralateral hemiplegia
• cortical sensory loss on the contralateral side
• dyspraxia
• reduced ability to make decisions
• slow to respond to commands
• perseveration
• reduced speech output
• incontinence
• facial/tongue weakness
• grasp/sucking reflex

Question 13

Posterior Communicating Artery

Answer 13

Supplies

• posterior limb of internal capsule
• medial thalamus
• central part of hypothalamus
• subthaalmus
• mamillary bodies
• optic chiasm
• lateral wall of 3rd ventricle

Symptoms

• visual disturbances
• hypothalamic dysfunction
• motor dysfunction

Question 14

Posterior Inferior Cerebellar Artery

Answer 14

Supplies

• cerebellum
• medullary tracts

Wallenburg’s/Lateral Medullary Syndrome

• ipsilateral loss of pain and temperature sensation face
• contralateral loss of pain and temperature body
• diminished touch sensation
• transient contralateral paresis
• lateral rectus palsy
• ipsilateral paralysis of muscles of soft palate, pharynx and larynx
• dizziness, nausea and nystagmus
• cerebellar ataxia
• poor balance
• Horner’s syndrome

Question 15

Posterior Cerebral Artery

Answer 15

Supplies

• posteriomedial parietal lobe
• corpus colossum
• inferior and medial part of temporal lobe
• medial and inferior surface occipital lobe

Ipsilateral Lesion

• homonymous hemianopia, visual inattention, visual anosognosia
• hemianaesthesia
• transient memory disturbances
• dyslexia
• dominant lesion = receptive aphasia

Weber’s/Medial Medullary Syndrome

Question 16

Dangerous Situations

Answer 16

vertebral artery dissection
bleed into brainstem or cerebellum
cerebral oedema midline shift - increased ICP, may result in decerebrate posturing
severe headache - indication
blown pupil = indication of increased ICP

Question 17

CN 3 Palsy/Weber’s Syndrome

Answer 17

downwards abducted eye
dilated pupil
ptosis of eyelid - unable to close or raise
diplopia

Question 18

Horner’s Syndrome

Answer 18

constricted pupil
partial ptosis
anhydrosis

Question 19

Facial Lesions UMN vs LMN

Answer 19

UMN - contralateral paralysis of lower quadrant of facial muscles
LMN - ipsilateral paralysis entire side of face