Stroke Pathology and Clinical Assessment

Question 1

Stroke

Answer 1

Neurological deficit of sudden onset and vascular origin that lasts more than 24 hours

Question 2

Transient ischaemic attack

Answer 2

Same as stroke but lasts less than 24 hours

Question 3

Stroke symptoms include loss of

Answer 3

Power, sensation, speech, vision, coordination

Question 4

Neurological history/examination findings

Answer 4

Motor and sensory weakness
Dysarthria/dysphasia 
Neglect/visuospatial problems
Vision loss in one eye or hemianopia
Gaze palsy
Ataxia/vertigo/incoordination/nystagmus

Question 5

Causes of stroke

Answer 5

Thrombus/embolism causing blockage of a blood vessel
Haemorrhage from rupture of blood vessel
Disease of vessel wall
Disturbance of normal properties of blood

Question 6

What brain arteries make up the Circle of Willis

Answer 6

Posterior, middle and anterior cerebral arteries
Internal carotid artery
Posterior and anterior communicating arteries

Question 7

Anterior cerebral artery supplies

Answer 7

Front of brain

Question 8

Posterior cerebral artery supplies

Answer 8

Back of brain

Question 9

The carotid system supplies

Answer 9

Most of the hemispheres and cortical deep white matter

Question 10

The vertebro-basilar system supples

Answer 10

Brain stem, cerebellum and occipital lobes

Question 11

Carotid system contains which arteries

Answer 11

Internal carotid, common carotid, anterior and middle cerebral

Question 12

Vertebro-basilar system contain which artieres

Answer 12

Posterior cerebral. basilar, vertebral, cerebellar

Question 13

Lobes of the brain

Answer 13

Temporal, frontal, parietal, occipital

Question 14

Brain stem function

Answer 14

Swallowing, breathing, heartbeat, wakefulness centre, other involuntary functions

Question 15

Cerebellum function

Answer 15

Coordination

Question 16

Anterior brain functions

Answer 16

Speech, smell, judgement, foresight, voluntary movement

Question 17

Middle brain functions

Answer 17

Movement, intellectual and emotional functions, pain, heat and other sensations, hearing

Question 18

Posterior brain functions

Answer 18

Comprehension of language, visual, speech comprehension

Question 19

Why will small stroke in internal capsule or brain stem result in a major deficit

Answer 19

Fibres packed closely together

Question 20

What percentage of stroke are caused by haemorrhage

Answer 20

15%

Question 21

What percentage of stroke are caused by infarction

Answer 21

85%

Question 22

Commonest cause of cardioembolic stroke

Answer 22

Atrial fibrillation

Question 23

Lacunar stroke

Answer 23

Stroke in small vessels of brain - deep white matter

Question 24

Lacunar stoke is caused by

Answer 24

Ischaemia

Question 25

Conditions that can lead to lacunar stroke

Answer 25

Hypertension | Diabetes

Question 26

Rarer cause of stroke

Answer 26

Carotid dissection

Question 27

Carotid dissection can be caused by

Answer 27

Idiopathic | Trauma

Question 28

Locked-in syndrome

Answer 28

Patient is aware but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in body apart from vertical eye movement and blinking

Question 29

Ischaemic stroke causes

Answer 29

``` Large artery atherosclerosis Cardioembolic Small artery occlusion Undetermined/cryptogenic Atrial dissection Venous sinus thrombosis ```

Question 30

Haemorrhagic stroke causes

Answer 30

Primary intracerebral haemorrhage | Secondary haemorrhage - subarachnoid or arteriovenous malformation

Question 31

Cortical stroke

Answer 31

Stroke involving the cortex

Question 32

Advantages of localisation of stroke

Answer 32

Confrims diagnosis Selection of imaging Indicates cause and prognosis

Question 33

Most common imaging method for stroke

Answer 33

MRI scan

Question 34

TACS

Answer 34

Total anterior circulation stroke

Question 35

PACS

Answer 35

Partial anterior circulation stroke

Question 36

LACS

Answer 36

Lacunar stroke

Question 37

POCS

Answer 37

Posterior circulation stroke

Question 38

Usual visual defect in stroke

Answer 38

Homonymous hemianopia

Question 39

TACS makes up what percentage of strokes

Answer 39

20%

Question 40

Cause of TACS

Answer 40

Occlusion of proximal middle cerebral artery or internal carotid artery

Question 41

Symptoms of TACS

Answer 41

Weakness Sensory deficit Homonymous hemianopia Higher cerebral dysfunction - dysphasia/dyspraxia

Question 42

PACS makes up what percentage of strokes

Answer 42

35%

Question 43

PACS affects

Answer 43

One side of the brain

Question 44

Symptoms of PACS

Answer 44

Partial motor and sensory deficit in one side, 2/3 body areas Higher cerebral dysfunction - dysphasia, visuospatial disturbances Homonymous hemianopia

Question 45

LACS makes up what percentage of strokes

Answer 45

20%

Question 46

Different types of LACS

Answer 46

Pure motor Pure sensory Sensorimotor

Question 47

Pure motor LACS

Answer 47

Complete or incomplete weakness of 1 side, 2/3 body areas

Question 48

LACS are under diagnosed because

Answer 48

They are often silent

Question 49

POCS makes up what percentage of strokes

Answer 49

25%

Question 50

POCS affect

Answer 50

Brainstem, cerebella or occipital lobes

Question 51

POCS symptoms

Answer 51

``` Bilateral motor/sensory deficit Disordered conjugate eye movement Coma Vertigo Disordered breathing Homonymous hemianopia Nerve palsy Tinnitus Horner's syndrome ```

Question 52

Risk factors for stroke

Answer 52

``` Hypertension Atrial fibrillation Age Race Family history ```