Stroke: Anatomy, causes/risk factors, clinical syndromes/investigations Flashcards Preview

NMH: Module 2 > Stroke: Anatomy, causes/risk factors, clinical syndromes/investigations > Flashcards

Flashcards in Stroke: Anatomy, causes/risk factors, clinical syndromes/investigations Deck (18)
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1

Define stroke

Acute onset neurological symptoms/signs indicative of focal CNS dysfunction, from vascular cause (ishaemia/haemorrhage) >24hrs

2

2 types of stroke?

Ischaemic (80%)
[- Arterial: AIS (acute ischaemic stroke) , Lacunar (slowly over time -> vascular dementia)
- Venous: central venous sinus thrombosis]

Haemorrhagic (20%)
[- Arterial: aneurysm (causing SAH) , arterio-venous malformation, PICH (primary intra-cerebral haemorrhage), EDH, AIS
- Venous: SDH (subdural haemorrhage), CVST, cavernoma]

3

Virchow’s Triad?

- Stasis

- Vessel-wall injury

- Hypercoagulability

4

What is a "silent stroke"

Right sided lesions can be a "silent stroke", as the left side is more critical for speech and language

5

Outcome of MCA infarct (clinical syndrome)

Hemiplegia (typically pts walk w/ arm flexed and leg extended)

6

Outcome of ACA infarct (clinical syndrome)

leg weakness > arm weakness (due to motor homunculus)

7

Outcome of PCA infarct (clinical syndrome)

Homonymous hemianopia (e.g. right occipital lobe damage -> can't see left hand side of each eye)

8

What is an endartery?

No collateral circulation- it is the only artery supplying that region of the brain and cannot be replaced

9

Cognitive syndromes post stroke (left hemisphere damage) + what brain lobe?

aphasia, apraxia (temporo-parietal)

10

Cognitive syndromes post stroke (right hemisphere damage) + what brain lobe?

neglect/ inattention (fronto-parietal)

11

Cognitive syndromes post stroke (frontal) + what brain lobe?

apathy, dysexecutive syndrome (Frontal Lobe Right/Left damage)

12

Posterior Inferior Cerebellar Artery (PICA) infact outcome?

ataxia in one limb, Horner’s syndrome, cranial nerve palsy

13

[Stroke pathology] outcome of thromboembolism

Territorial Stroke

14

[Stroke pathology] outcome of hypoperfusion i.e. complete blockage of an artery

infarction in “watershed zone” (area furthest away from each arterial branch)

15

[Stroke pathology]
Lacunar infarction

infarction of small deep penetrating artery

caused by: HTN, ageing , diabetes, renal disease, migraine; (rare: CADASIL)

can result in dementia/parkinsonism

16

In a stroke, damage to the ___ is usually irreversible
However damage to the ___ is potentially reversible

In a stroke, damage to the core (in middle) is usually irreversible
However damage to the penumbra (i.e. area surrounding the core) is potentially reversible

17

Cerebral blood flow thresholds based on the core-penumbra model

<10 ml/100g/min: necrosis (irreversible)
10-20 ml/100g/min: reversible e.g. w/ tPA
35-50 ml/100g/min: normal brain

18

What is supplied by the endarteries of the MCA?

Basal ganglia and internal capsule