Week 17 - Nervous System Flashcards by Lucy Gallagher

What are the 2 main types of stroke?

Ischaemic
Haemorrhagic

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What are some common symptoms of a stroke?

Typically asymmetrical
- limb weakness
- facial weakness
- dysphagia
- visual field defects
- sensory loss
- ataxia
- vertigo

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What defines a TIA?

Temporary neurological dysfunction (<24hrs)
Caused by ischaemia but without infarction

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What are crescendo TIAs?

2 or more TIAs within a week

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What can be the causes of ischaemia in a stroke?

Embolism
Thrombosis
Systemic hypoperfusion
Cerebral venous sinus thrombosis

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What is the classification system of Ischaemic stroke? What are the types?

Bamford classification
- total anterior circulation stroke
- partial anterior circulation stroke
- posterior circulation syndrome
- lacunae stroke

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What is the criteria for a total anterior circulation stroke?

All 3 of the following must be present:
• Unilateral weakness (and/or sensory deficit) of the face, arm and leg
• Homonymous hemianopia
• Higher cerebral dysfunction (dysphasia, visuospatial disorder)

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What is the criteria for a partial anterior circulation stroke?

2 of the following need to be present:
• Unilateral weakness (and/or sensory deficit) of the face, arm and leg
• Homonymous hemianopia
• Higher cerebral dysfunction (dysphasia, visuospatial disorder)*

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What is the criteria for posterior circulation syndrome?

1 of the following needs to be present:
• Cranial nerve palsy and a contralateral motor/sensory deficit
• Bilateral motor/sensory deficit
• Conjugate eye movement disorder (e.g. horizontal gaze palsy)
• Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
• Isolated homonymous hemianopia

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What is the criteria for a lacunae stroke?

1 of the following needs to be present:
• Pure sensory stroke
• Pure motor stroke
• Sensori-motor stroke
• Ataxic hemiparesis

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What is a total anterior circulation stroke?

Large cortical stroke affecting the areas of the brain supplied by both the middle and anterior cerebral arteries

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What is a partial anterior circulation stroke?

Less severe form of TACS
Only part of the anterior circulation has been compromised

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What is posterior circulation syndrome?

Involves damage to the area of the brain supplied by the posterior circulation e.g. Cerebellum and brainstem

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What is a lacunar stroke?

Subcortical stroke
Occurs secondary to small vessel disease
No loss of higher cerebral function

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What are the 2 subtypes of haemorrhagic stroke?

Intracerebral haemorrhage
Subarachnoid haemorrhage

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What is the most common cause of a subarachnoid haemorrhage?

Berry aneurysm in the circle of Willis

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Where do posterior cerebral arteries supply?

Mixture of medial and lateral areas of the posterior cerebrum

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Where do the middle cerebral arteries supply?

Majority of the lateral cerebellum

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Where do the anterior cerebral arteries supply?

Ateromedial area of the cerebrum

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What symptoms are seen in a blockage of the anterior cerebral artery?

Weakness of contralateral leg
Behaviour changes

Typically present with weakness and sensory loss in the lower leg and foot opposite the lesion, incontinence and behaviour changes

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What symptoms are seen in a blockage of the middle cerebral artery?

Weakness of contralateral face and arm
Speech disturbance
Visual field defect
Intattention to stimuli
Sensory defecits

Typically present with symptoms most associated with stroke

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What symptoms are seen in the blockage of the posterior cerebral artery?

Visual field defects
Sensory defecits

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What symptoms are seen with a lesion in the vertebrobasilar system?

Dizziness
Ataxia
Impaired balance
Pupil and eye movement abnormalities
Changes in voice and swallowing
Weakness and sensory changes
Decreased level of consciousness

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What is found in grey matter?

Cell bodies
Cerebral cortex

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What is found in the white matter?

Glial cells and myelinated axons

What are the 4 lobes of the brain?

Frontal Parietal Temporal Occipital

What is the function of the frontal lobe?

Higher intellect Personality Mood Social conduct and language

Where is the broca region located?

Frontal lobe

What is the function of the parietal lobe?

Language Calculation Visuospatial function

What is the function of the temporal lobe?

Memory Language Hearing

Where is wernickes area located?

Temporal lobe

What is Broca’s area for?

Language retrieving

What is wernickes area for?

Language articulating

What is the function of the occipital lobe?

Vision

What is the function of the pons?

Handles unconscious processes and jobs E.g. sleep wake cycle, breathing

What is the function of the medulla?

Helps control vital processes E.g. heartbeat, breathing, BP

What is the function of the cerebellum?

Helps maintain balance and posture

What is the secondary prevention after someone’s had a stroke?

Clopidogrel 75mg once daily Atorvostatin 20-80mg (delayed to at least 48 hours after event) BP and diabetes control Manage modifiable risk factors e.g. smoking, obesity and exercise

What are the driving restrictions after a stoke?

Not allowed to drive for 1 month Don’t need to tell DVLA if it’s TIA or Ischaemic stroke Need to notify DVLA if it’s a haemorrhagic stroke Should always personally tell DVLA of attack especially if HGV driver

What is the function of the primary motor cortex when communicating with corticospinal tract?

Execution of movement

What is the function of the premotor cortex when communicating with the corticospinal tract?

Control of behaviour especially of trunk muscles

What is the function of the supplementary motor cortex when communicating with the corticospinal tract?

Stabilisation and coordination of the body during bimanual movements

Where do nerves of the lateral corticospinal tract cross?

Medulal

Where do nerves of the anterior corticospinal tract cross?

At level the spinal nerves enter

Where do UMN and LMN synapse in the corticospinal tract?

Ventral horn

Where do UMNs from the trigeminal (corticobulbar) tract arise?

Lateral aspect of the primary motor cortex

Where do nerves of the trigeminal (corticobulbar) tract supply?

Muscles of head and neck

What are the 3 layers of the meninges?

Dura mater - adhears to skull Arachnoid Mater - directly beneath dura Pia mater - adhears to brain and spinal cord

What are the 2 functions of the meninges?

Provide a supportive framework for vessels Form distinct comoartments to prevent injury

Where is CSF produced?

Choroid plexus

What is the function of CSF in the ventricles of the brain?

Protect brain against trauma Provide nutrients Removes waste product

What connects the lateral ventricles to the 3rd ventricle?

Interventricular foramina

Where CSF reabsorbed?

Arachnoid granulations

What type of cells are found in the choroid plexus?

Cuboidal epithelial cells

What is the main Thrombolysis given in Ischaemic stroke?

Alteplase

What 2 conditions must be met before giving Alteplase Thrombolysis in a stroke event?

Must be administered within 4.5hrs of stroke symptoms Haemorrhage must be definitively excluded

What are the most common causes of an UMN lesion?

Stroke MS B12 deficiency Brown-sequard syndrome Trauma Tumours Severe infection Dementia

What does babinskis sign show?

UMN lesion

What are some clinical signs of an UMN lesion?

• Disuse atrophy (minimal) or contractures • Increased tone (spasticity/rigidity) +/- ankle clonus • Pyramidal pattern of weakness (extensors weaker than flexors in arms, and vice versa in legs) • Hyperreflexia • Upgoing plantars (Babinski sign)

What 2 features are associated with an UMN lesion and which 2 are associated with a LMN lesion?

UMN = hypertonia, spastic paralysis LMN = hypotonia, flaccid paralysis

What are some causes of LMN lesions?

Trauma to peripheral nerves Viruses that attack ventral horn cells

What clinical signs are seen in a LMN lesion?

• Marked atrophy • Fasciculations • Reduced tone • Variable patterns of weakness • Reduced or absent weakness • Downgoing plantars or absent response

What symptoms does damage to Broca’s area cause?

○ Dysfluency ○ Impaired grammatical structure ○ Absence of small linking words ○ Slow, but comprehensible speech

What symptoms are seen when there is damage to wernickes area?

○ Fluent speech lacking in meaningful content ○ Patients unaware of the scale of their aphasia

What is the angular gyrus responsible for?

Reading and writing Allows us to associate multiple types of language related info

What symptoms are seen in damage to the angular gyrus?

○ Alexia - inability to recognize or read written words or letters, typically as a result of brain damage ○ Agraphia - inability to write letters, symbols, words, or sentences, resulting from damage to various parts of the brain.

What is dysdiadochokinesia?

Inability to do rapid alternating movements

What is the most common cause of a subarachnoid haemorrhage?

Uncontrolled hypertension

What is the first investigation done in suspected stroke?

Non contrast CT head Rule out haemorrhage

What is the suggested treatment for Bell’s palsy?

Prednisolone 30mg if symptoms presented in last 72hrs

Week 17 - Nervous System Flashcards

(70 cards)