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Flashcards in Stroke and neuroanantomy Deck (35)
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1
Q

UMN signs

A
Tone increased
Power reduced
Reflexes increased
Plantar upgoing
Clonus present
2
Q

LMN signs

A
Tone decreased
Power reduced
Reflexes none
Plantars down
Clonus Nil
3
Q

Frontal lobe functions

A
Primary motor cortex
Personality
Primitive reflexes
Dysphasia expressive if dominant
Anosmia
Optic nerve compression
Gait apraxia
4
Q

Parietal lobe functions

A
Primary sensory cortex
Gerstmann syndrome - dominant, acalculia, agraphia, L-R disorientation, finger agnosia (ALF)
Sensory, visual and spatail inattention
Construction and dressing apraxia
Lower quandrantanopia
5
Q

Temporal lobe functions

A

Primary auditory cortex
Receptive dysphasia (dominant)
Memory loss
Upper quandrantanopia

6
Q

Occipital lobe functions

A

Homonymous hemanopia
Anton’s syndrome (individual denies their blindness)
Alexia

7
Q

Blood supply to internal capsule?

A

Lenticulostriate arteries which are penetrating branches from the MCA M1

8
Q

Course of the corticospinal tract?

A
Primary motor cortex
through internal capsule
Crus cerebri in midbrain
Pons
Medulla
Crosses over at Lower medulla
Spine
9
Q

Function of the thalamus? Rules of 4

A

Anterior nuclei involved with language and memory function
Lateral nuclei involved mainly with motor and sensory function
Medial nuclei important for maintaining arousal and memory
Posterior nuclei involved mainly with visual function

10
Q

Course of spinothalamic tract?

A
Sensory nerve -> dorsal root ganglion of the spine and crosses over immediately
Medulla
Pons
Midbrain
Thalamus
Primary sensory cortex
11
Q

Course of dorsal column tract (vibration, light touch, propioception)

A

Senosry nerve -> dorsal root ganglion -> dorsal column
Lower medulla -> crosse over at medial leminiscus
Medulla
Pons
Midbrsin
Thalamus

12
Q

Brainstem. Rule of 4s?

A

4 cranial nerves in the medulla, 4 in the pons and 4 above the pons

There are 4 structures in the midline beginning with M

4 structures to the side beginning with S

4 motor nuclei that are midline are those that divide equally into 12 (except for 1 and 2) i.e. 3,4,6,12

13
Q

The 4 medial structures are?

A

Motor pathway
Medial lemniscus
Medial longitudinal fasciculus and
Motor nucleus

14
Q

4 side structures are?

A

Spinocerebellar pathways
Spinothalamic
Sensory nucleus of 5th CN
Sympathetic tract

15
Q

Blood supply of the brainstem

A

Superior cerebellar artery
Anterior inferior cerebellar artery
Posterior inferior cerebellar artery

Occlusion of unilateral verterbrals can cause lateral brainstem syndromes

16
Q

What are the lacunar syndromes (5 types)?

A
  1. Pure motor
    - 33-50% of lacunar strokes
    - posterior limb of internal capsule or anterior portion of pons
  2. Ataxic hemiparesis
    - posterior limb of internal capsule
    - combination of cerebellar and motor symptoms
    - usually affects the legs more than the arms hence it is known as homolateral ataxia
  3. Dysarthria/Clumsy hand
    - Basis pontis
  4. Pure sensory
    - Thalamic infarct
  5. Mixed sensorimotor
    - thalamus and posterior limb of internal capsule
17
Q

Post stroke BP care. What are the limits?

A

tPA - BP 180/105 and then lower
No tPA - BP 220/120 and then lower
Increased systemic BP will improve blood flow tot he cerebral infarct via collateral blood vessels

18
Q

Cause of anterior circulation stroke?

A

Intracranial stenosis
Severe carotid stenosis
Aortic arch
AF

19
Q

Cause of posterior circulation stroke?

A

Atheroembolic disease

AF

20
Q

What is the single most important modifiable RF for ischaemic and haemorhhagic stroke?

A

HT
Goal 120-140 mmHg
ACE/ARB and thiazide diuretic have better evidence

21
Q

When do you give antiplatelets in stroke?

A

Post CTB and 24 hrs post t-PA

Aspirin, clopidogrel and asasantin are all appropriate 1st line therapy

22
Q

what is the reversal agent for Dabigatran?

A

Idarucizumab (Praxbind)

23
Q

Dabigatran and Rivaroxiban had higher rates of GI bleed compared with warfarin. T/F

A

True

24
Q

Apixiban 5 mg BD demonstrated what benefits?

A

Superior to warfarin
Decreased rates of all cause bleeding
Decreased rates if ICH
Mortality benefit

25
Q

Intracranial atherscerlosis. Tx? Risk of recurrence

A

Tx - aspirin and aggressive medical Mx
No difference between aspirin and warfarin with more complications on warfarin
No role for intracranial stenting due to increasing complications

Recurence is 12-14% in 2 years despite antiplatelets
Higher rates amongst Asians

26
Q

ICH. Location of bleed and corresponding aetiology?

A

Intracerebral

  • basal ganglia = HTN
  • Lobar = amyloid angiopathy
  • Pontine = HTN, vascular malformation
  • Cerebellar = HTN, vascular malformation, tumour

Intraventricular

  • Primary = tumours and malformations
  • secondary = ICH, SAH
27
Q

What is the Mx of an ICH stroke?

A

Aim BP 140/80 mmHg

28
Q

AICA stroke. Areas affected.

A

CN V, VII and VIII
Inner ear, lateral pons, middle cerebellar peduncle and anterior inferior cerebellum
pseudo-labrynthitis

29
Q

PICA stroke. Areas affected?

A

CN VI, VIII, IX, X
Lateral medullary syndrome
Acute vestibular syndrome without hearing loss or pseudo-neuritis

30
Q

Head impulse test. Positive in which lesions?

A

Peripheral lesions

Asent in central lesions

31
Q

How does a dissection present?

How do you differentiate between a vertebral and carotid artery dissection?

A

H/O trauma, headache, neck pain and Horner’s syndrome.

Both will present with Horner’s syndrome.

Dizziness is associated with vertebral artery dissection.

32
Q

Cervical nerves exit above or below the vertebra?

Spinal nerves?

A

Exit above
Except for C8, exits above T1

Spinal nerves exit below the vertebra starting with T1

33
Q

Grey matter:
Anterior horn
Posterior horn

A

Anterior horn:
lower motor neurons as well as interneurons that help to fine tune the motor output

Posterior horn:
Secondary sensory neurons and interneurons receiving input from the dorsal root ganglia (primary sensory neurons)
Outermost layer serves as superficial sensations including pain, temp and light touch.

34
Q
Cerebral venous thrombosis.
Epid
Patho
Presentation
Mx
A

Epid:
Increased risk with hormonal Tx and post partum
12 in 100 000 pregnancies

Patho:
Thrombosis leads to increased capillary and venous pressure -> ischaemia, haemmorhage
Sinus obstruction leads to poor CSF absorption -> raised ICP

Presentation:
Raised ICP 90%
- subacute headache, visual changes, papilloedema
Focal neurological abnormalities 44%
Seizures 33%
Encephalopathy - usually elderly pts

Mx:
Anticoagulation
- Heparin infusion or therapeutic clexane
- transition to warfarin
- 3-6 months in provoked and 6-12 months in unprovoked
Fibronolysis in severe cases

Raised ICP

  • acetazolamide
  • may need Sx intervention if severe

Hemicranectomy

35
Q

OCP and stroke. What are the risk?

A

Slightly higher risk in older age groups.
No difference between 2nd and 3rd generation OCP.
No increased risk with low oestrodial.