Week 4

Question 1

Where does most brain blood flow come from?

Answer 1

80% from internal carotid arteries which feed the circle of willis

Question 2

what brain circulation feeds optic nerves, frontal, parietal and temporal loads?

Answer 2

Anterior circulation

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Question 3

What part of brain circulation provides 20% of the supply?

Answer 3

Posterior circulation

Question 4

What parts of the brain does the basilar arteries feed?

Answer 4

gives off arteries to the cerebellum, brain stem, thalamus, occipital lobe, temporal lobe

Question 5

what area is responsible for touch, proprioception, pain, itching, tickle, thermal?

Answer 5

Primary somatosensory area

Question 6

what area is responsible for controlling voluntary muscle contractions?

Answer 6

Primary motor area

Question 7

what area is responsible for control of sequential contraction of specific muscle eg writing, speaking

Answer 7

Premotor area

Question 8

what area is responsible for speaking and understanding speech?

Answer 8

Broca’s area

Question 9

what area is responsible for recognition of shape, colour and movement of visual stimuli

Answer 9

primary visual area

Question 10

what area is responsible for interpreting the meaning of speech and recognising spoken word

Answer 10

Wernicke’s area

Question 11

how much of the bodies volume does the brain represent?

Answer 11

2%

Question 12

how much cardiac output does the brain require?

Answer 12

15-20% of total resting cardiac output to supply needed glucose and O2 for normal metabolism

Question 13

Define a stroke?

Answer 13

Any disturbance of cerebral function (>24hours) caused by abnormalities of blood vessels

Question 14

What are the 3 types of stroke

Answer 14

• Hemorrhagic stroke
• Ischaemic stroke (can be thrombotic of embolic clots or hypoperfusion)
• Transient ischaemic attack

Question 15

WHat are the causes of an ischaemic stroke?

Answer 15

• thrombotic
• embolic
• hypo perfusion

Question 16

what are the caused of a hameorrhagic stroke?

Answer 16

• intercerebral
• subarachnoid
• extradural
• subdural

Question 17

what percentage of strokes do ischaemic strokes account for?

Answer 17

85%

Question 18

what is the most common cause of ischaemic stroke?

Answer 18

atheroscleoris

Question 19

what are some common sites of ischaemic strokes?

Answer 19

• carotid bifurication
• origin of MCA
• both ends of basilar artery

Question 20

How quickly does cell death occur with ischaemic stroke?

Answer 20

1.9milli/min

Question 21

what causes 50% of all haemorrhagic strokes?

Answer 21

hypertension

• accelerates atherosclerosis
• other damaging effects

Question 22

what are some S&S for Subarachnoid Haemorrhgae?

Answer 22

• sever sudden onset headache
• neck stiffness
• photophobia
• low back pain (due to inflammatory response)
• Nausea & vomitting (increased ICP & Meningeal irritation
• May have altered LOC
• 10-25% suffer siezures

Some people have symptoms up to 10-20 days before rupture

Question 23

What is GRADE ONE of the 5 grades of subarachnoid hamorrhage?

Answer 23

– Grade I: Mild headache with or without meningeal irritation

Question 24

What is GRADE TWO of the 5 grades of subarachnoid hamorrhage?

Answer 24

Grade II: Severe headache and a nonfocal examination, with or without mydriasis

Question 25

What is GRADE THREE of the 5 grades of subarachnoid hamorrhage?

Answer 25

Grade III: Mild alteration in neurologic examination, including mental status

Question 26

What is GRADE FOUR of the 5 grades of subarachnoid hamorrhage?

Answer 26

Grade IV: Obviously depressed level of consciousness or focal deficit

Question 27

What is GRADE FIVE of the 5 grades of subarachnoid hamorrhage?

Answer 27

Grade V: Patient either posturing or comatose

Question 28

what is a TIA?

Answer 28

TIA is a transient episode of cerebral or retinal dysfunction (amaurosis fugax) • Results from inadequate supply of blood to the brain • Lasts less than 1 hour • A stroke warning sign

Question 29

What are symptoms of a TIA?

Answer 29

– Temporary hemipegia (unilateral weakness) – Hemiparesis (altered sensation on one side of the body) – Dysphagia or aphasia (difficulty or inability to speak) – Visual loss – Ataxia (altered balance or co-ordination) – Vertigo

Question 30

AFter a TIA, what is the liklinhood that a patient will have a stroke?

Answer 30

20% half of those will occur within 48 hours

Question 31

If you have a stroke on your right side of your brain ,wjhat symtoms may you show?

Answer 31

– Problems with movement on the left side of the body – Lack of feeling on the left side of the body – Trouble thinking clearly, solving problems or concentrating – Impulsive behaviour – Trouble estimating distance, size, position, or shapes – Decreased facial expression or difficulty maintaining eye contact

Question 32

If you have a stroke on your LEFT side of your brain ,wjhat symtoms may you show?

Answer 32

– Problems with movement or no movement on the right side – Lack of feeling to the right side of the body – Trouble speaking, understanding what others are saying – Trouble reading, writing or listening

Question 33

If you have a stroke on your CEREBELLUM of your brain ,wjhat symtoms may you show?

Answer 33

``` – Dizziness – Loss of balance – Loss of co‐ordination – Slurred speech – Nausea & vomiting ```

Question 34

If you have a stroke on your BRAIN STEM of your brain ,wjhat symtoms may you show?

Answer 34

• The brain stem connects the 2 hemispheres with the spinal chord. As a result a stroke in the brain stem may affect both sides of the body. • The brain stem also helps control speech, swallowing, eye movements, breathing, heart rate & blood pressure. ``` • Some of the changes in a brain stem stroke include: – Coma – Total paralysis of both sides of the body – Problems with speech – Problems swallowing – Double vision – Nausea & vomiting – Hiccups ```

Question 35

What are some clinical features of a stroke?

Answer 35

* limb weakness or paralysis * facial paralysis * sensory loss * slurred speech (dysarthria) * Inappropriate or jumbled speech (dysphasia) * Visual loss (hemianopia) * Gaze deviation * Poor balance, unsteady gait (ataxia) * Difficulty swallowing (dysphagia) * Double vision (diplopia) * 80-90% have some motor deficit at stroke onset

Question 36

What are some stroke mimics?

Answer 36

* Electrolyte disturbances (Na+, K+, Ca2+) * Hypoglycaemia or hyperglycaemia * Seizures (absence, post ictal states) * CNS infections (encephalitis) * Brain tumour * Syncope * Middle ear (vestibular) disorders * Stress * Migraine * Systemic infection (sepsis) * Intoxication (drugs or alcohol) * Trauma (subdural haematoma)

Question 37

What is the national institute of stroke scales?

Answer 37

 Used for all patients with a stroke.  Is a tool used to assess 11 elements of neurological impairment.  Originally used as a research tool is now the Gold Standard for stroke measurement.  It measures neurological function and helps to determine stroke severity

Question 38

what is the criteria for thrombolysis

Answer 38

– Clear onset of ischaemic stroke symptoms within the preceding 4.5hrs – Measurable and clinically significant deficit as assessed by the Medical Registrar in discussion with either the stroke Physician or the Physician on call. – Pt’s CT does not show haemorrhage or non‐vascular cause of stroke.