STROKES

Question 1

Define TIA.

Answer 1

An episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia without evidence of acute ischaemia, lasting <24 hours.

Question 2

Define stroke.

Answer 2

A clinical syndrome characterised by sudden onset of rapidly developing focal or global neurologic

Question 3

Causes of an ischaemic stroke?

Answer 3

Embolism: embolus originating elsewhere in the body causes obstruction of a cerebral vessel = hypoperfusion to area supplied by brain.

Thrombosis: blood clot forms locally within cerebral vessel (atherosclerotic plaque rupture).

Systemic hypoperfusion: blood supply to entire brain is reduced (e.g. in CA).

Cerebral venous sinus thrombosis: blood clot formation in veins that drain the brain = venous congestion and tissue hypoxia.

Question 4

Causes of a haemorrhage stroke?

Answer 4

Intracerebral haemorrhage: bleeding within the brain secondary to a ruptured blood vessel. Can be intraparenchymal and/or intraventricular.

Subarachnoid haemorrhage: bleeding between the pia mater and arachnoid mater.

Question 5

Criteria for a total anterior circulation stroke (TACS)?

Answer 5

All 3 of the following present:

1) Unilateral weakness and/ or sensory deficit or face, arm + leg.
2) Homonymous hemianopia.
3) Higher cerebral dysfunction (dysphasia/ visuospatial disorder).

Question 6

Criteria for a partial anterior circulation stroke (PACS)?

Answer 6

2 of the following present:

1) Unilateral weakness and/ or sensory deficit or face, arm + leg.
2) Homonymous hemianopia.
3) Higher cerebral dysfunction (dysphasia/ visuospatial disorder).

Question 7

Criteria for a posterior circulation syndrome (POCS)?

Answer 7

Any 1 of the following present:

1) Ipsilateral CN palsy + CL motor/sensory deficit.
2) Bilateral motor/ sensory deficit.
3) Conjugate eye movement disorder (e.g. horizontal gaze palsy)
4) cerebellar dysfunction (vertigo, nystagmus, ataxia).
5) Isolated homonymous hemianopia.

Question 8

Criteria for a lacunar stroke?

Answer 8

Any 1 of the following present:

1) Pure sensory stroke.
2) Pure motor stroke.
3) Sensori-motor stroke
4) Ataxic hemiparesis.

Question 9

Symptoms of an anterior cerebral artery stroke?

Answer 9

Contralateral hemiparesis + sensory loss.

Lower extremities worse than upper.

Question 10

Symptoms of a middle cerebral artery stroke?

Answer 10

Contralateral hemiparesis + sensory loss.

Upper extremities worse than lower.

Contralateral homonymous hemianopia.

Aphasia.

Question 11

Symptoms of a posterior cerebral artery stroke?

Answer 11

Contralateral homonymous hemianopia with macular sparing.

Visual agnosia.

Question 12

Symptoms of Weber’s syndrome?

Answer 12

Ipsilateral CN III palsy.

Contralateral weakness of upper and lower extremities.

Question 13

Symptoms of a retinal/ ophthalmic artery stroke?

Answer 13

Amaurosis fugax.

Question 14

Symptoms of a posterior inferior cerebellar artery stroke?

**AKA lateral medullary syndrome/ wallenburh syndrome.

Answer 14

Ipsilateral facial pain + temperature loss.

Contralateral limb/ torso pain + temperature loss.

Ataxia.

Nystagmus.

Question 15

Symptoms of an anterior inferior cerebellar artery stroke?

**AKA. lateral pontine syndrome.

Answer 15

Ipsilateral facial pain, temperature loss + paralysis.

Ipsilateral deafness.

Contralateral limb/ torso pain + temperature loss.

Ataxia.

Nystagmus.

Question 16

Symptoms of a basilar artery stroke?

Answer 16

Locked in syndrome.

Question 17

Symptoms of a lacunar stroke?

Answer 17

Isolated hemiparesis/ hemisensory loss/ hemiparesis with limb ataxia.

• strong association with HTN.
• *common sites include basal ganglia, thalamus and internal capsule.

Question 18

Symptoms of cerebral infarcts?

Answer 18

CL sensory loss or hemiplegia (flaccid to spastic)
Dysphasia
Homonymous hemianopia
Visuo-spatial defects

Question 19

Symptoms of brainstem infarcts?

Answer 19

Quadriplegia
Visual disturbances
Locked in syndromes

Question 20

Symptoms of lacunar infarcts?

Answer 20

Ataxic hemiparesis
Pure motor/ pure sensory syndrome
Sensorimotor syndrome
Dysarthria

**Cognition + consciousness intact except from in thalamic strokes.

Question 21

Symptoms of posterior circulation infarcts?

Answer 21

Acute, persistent + continuous vertigo with nystagmus.
N+V.
Head motion intolerance.
New gait ataxia. 
Truncal instability.