Stroke - Presentation & Investigation Flashcards by Liam McCreadie

What is a stroke?

Neurological deficit (‘loss of function’) of sudden onset, lasting more than 24 hours, of vascular origin.

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What is a stroke also known as?

Transient ischaemic attack (TIA)

Cerebrovascular accident (CVA)

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What are the symptoms of a stroke?

loss of power
loss of sensation
loss of speech (dysphasia)
loss of vision
loss of coordination

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What is dysarthria?

slurred/slow speech

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What is dysphasia?

loss of speech

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What are the findings on taking a neurological history/examination of a stroke patient?

loss of motor function
loss of sensory function
impaired speech
loss of spatial awareness
loss of vision
ataxia
vertigo
nystagmia

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Outline the two main types of stroke?

haemorrhage

- thromboembolus/embolus

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If a stroke patient has headache, vomiting, neck stiffness or photophobia what does this suggest?

haemorrhage

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What is nystagmia?

condition in which the eyes make repetitive and uncontrolled movements, sign of stroke.

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What is ataxia?

neurological sign consisting of lack of voluntary coordination of muscle movements, sign of stroke

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What is gaze palsy?

an inability to move both eyes in a single direction

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How would a haemorrhage appear on a head CT?

areas of white (haemorrhaged blood)

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How would an ischaemic stroke appear on a head CT?

areas of dark (water), squashed midline

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What is penumbra?

tissue that is alive but not perfused. It is at risk of infarction but can be saved if reperfused

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What are the three circulations within the brain?

anterior circulation
posterior circulation
circle of Willis

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The carotid system supplies most of the ______ and _______________.

hemispheres

cortical deep white matter

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The vertebro-basilar system supplies the ___________, _________ and _____________.

brain stem
cerebellum
occipital lobes

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What is the Broca’s area of the brain responsible for?

speech

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What is the frontal lobe responsible for?

judgement
foresight
voluntary movement
smell

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What is the motor cortex of the brain responsible for?

movement

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What is the sensory cortex of the brain responsible for?

heat, pain and other sensations

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What is the parietal lobe responsible for ?

comprehension of language

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What is the temporal lobe responsible for?

hearing

intellectual and emotional functions

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What is the occipital lobe responsible for?

vision

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What is the Wernicke's area of the brain responsible for?

speech comprehension

What is the cerebellum responsible for?

coordination

What is the brainstem responsible for? | 5

``` swallowing breathing heart beat wakefullness centre other involuntary functions ```

If a stroke is small and affects deep white matter, what will the result be?

It will result in a major deficit as the fibres are packed close together.

Outline the causes of stroke. | 4

- Blockage of a vessel with thrombus/clot - Disease of vessel wall - Disturbance of normal properties of blood - Rupture of vessel wall (haemorrhage)

What type are the majority of strokes?

ischaemic

What are the causes of ischaemic stroke, specifically?

- carotid stenosis - cardioembolic - small artery stroke - rare causes: arterial dissection, CVST - idiopathic

What is the name given to a stroke due to small vessel occlusion?

lacunar stroke

What is a cardioembolic stroke? What is the main cause of them?

- when the heart pumps unwanted materials into the brain circulation, resulting in the occlusion of a brain blood vessel and damage to the brain tissue. - atrial fibrillation

What causes carotid stenosis? Where in the carotid does this occur?

atherosclerosis at the bifurcation

What are two kinds of haemorrhagic stroke?

- primary intracerebral haemorrhage | - secondary haemorrhage (subarachnoid or atriovenous malformation)

What does the internal carotid artery supply?

brain

What does the external carotid artery supply?

face

What are the symptoms of stroke dependant of?

the artery or area of the brain affected

What are the different areas of the brain that stroke can affect? (4)

- Left or right - Carotid/vertebrobasilar territory - Cerebral hemispheres or brainstem - Cortex or deep white matter

What is the main problem caused by brain stem strokes?

inability to swallow

Why is it important to localise stroke? | 4

- confirms the diagnosis of a stroke - allows better selection of imaging - gives an indication of cause - gives an indication of prognosis

What is unilateral field loss?

loss of vision in one eye

What is bitemporal hemianopia?

loss of vision from one half of each, the loss is in the opposite halves

What is homonymous hemianopia?

loss of sight from one side in both eyes, the loss is from the same side in both eyes

Homonymous hemianopia with right sided vision defect is indicative of what?

left cerebrovascular accident/event

What is a total anterior circulation stroke (TACS) due to?

occlusion of proximal middle cerebral artery or internal carotid artery

What are the symptoms/signs of TACS? | 3

- weakness/sensory deficit - homonymous hemianopia (loss of vision) - Higher cerebral dysfunction (e.g. dysphasia)

What is partial anterior circulation stroke (PACS) caused by?

occlusion of branches of middle cerebral artery (more restricted cortical infarcts)

What are the symptoms/signs of PACS?

2/3 of the TACS symptoms: - weakness/sensory deficit - homonymous hemianopia (loss of vision) - Higher cerebral dysfunction (e.g. dysphasia)

What is occluded in a lacunar stroke (LACS)?

lacunar artery (smaller vessel)

What can the symptoms associated with LACS differ? | 3

- pure motor - pure sensory - sensorimotor

What are the pure motor symptoms of LACS?

- Complete/incomplete weakness of one side. | - involving 2/3 body areas (face/arm/leg)

What are the pure sensory symptoms of LACS?

same distribution as motor, but sensory

Which areas does posterior circulation strokes (POCS) affect? (3)

brainstem, cerebellar or occipital lobes.

What are the symptoms/signs of POCS? | 8

- bilateral motor/sensory deficit - disordered conjugate eye movement - isolated homonymous hemianopia - coma - disordered breathing - tinnitus - vertigo - Horner’s

Which classification of stroke has the best prognosis?

LACS

Which classification of stroke has the poorest prognosis?

TACS

Which classification of stroke has the highest recurrence rate?

PACS

What are the modifiable risk factors associated with stroke?

- high BP | - AF

What are the non-modifiable risk factors associated with stroke?

- age - gender - FH