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Neurology and psychiatry > Strokes > Flashcards

Flashcards in Strokes Deck (23)
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1
Q

That is a TIA?

A

A stroke but they recover within 24 hrs of onset of symptoms

2
Q

What is a stroke?

A

Damage or killing of brain cells starved of oxygen as a result of blood supply to part of the brain being cut off.

3
Q

Describe the changes seen on CT of someone with an ischaemic stroke?

A

Sometimes seen hypersense artery, grey matter becomes hypodense (darker) and loss of white. grey matter differentiation

4
Q

Describe the changes seen with CT of haemorrhagic stroke?

A

Hyperdense area (white) seen as location of bleed

5
Q

Where can emboli causing strokes come from?

A

AF, prosthetic heart valves, septic endocarditis, aorta, carotid sinus, vertebral/ basilar arteries, vasculitis, sickle cell anaemia, cocaine (coke stroke)

6
Q

Which part of the brain will be affected by left anterior cerebral artery strokes?

A

The medial aspects of the left frontal and parietal lobes and anterior part of the corpus callosum

7
Q

Describe 3 deficits seen with left anterior cerebral artery strokes?

A
  • medial motor and sensory homonculus loss= contralateral loss of all modalities in lower limbs + spinal shock and then UMN signs in contralateral lower limbs
  • loss of volunatry micturition as L center is found in paracentral lobule of parietal lobes
  • anterior corpus callosum loss may lead to split brain syndrome or alien hand syndrome
8
Q

Which areas of the brain does the middle cerebral artery supply?

A

the lateral parietal and temporal lobes- basal ganglia, internal capsule, macular cortex

9
Q

What is a malignant MCA stroke?

A

Occlusion to the main trunk of the middle cerebral artery leading to significant odema and swelling which often leads to death and coma

10
Q

What is the difference in motor and sensory loss in MCA strokes before and after the lenticulostriate arteries branch off.

A

If after- lateral motor and sensory homonculus lost leading to contralateral sensory loss of all modalities in upper limb and face + contralateral motor loss of upper limb and face (spinal shock then UMN signs).
If before- lenticulostriate arteries also lose blood supply -> loss of blood supply to internal capsule-> motor loss of contralateral lower limb also

11
Q

What is the difference in visual loss due to proximal and distal MCA strokes?

A
Proximal= superior AND inferior radiations affected-> contralateral homonymous hemianopia
Distal= superior OR inferior radiations affected-> contralateral superior or inferior quadrantanopia
12
Q

What type of stroke may lead to a global aphasia?

A

Proximal, left MCA stroke (main trunk)- may be before or after lenticulostriate artery branches

13
Q

Occlusion of which divisions of the MCA will lead to receptive and expressive aphasias?

A
Receptive= wernickes lost= inferior division of MCA stroke (left)
Expressive= brocas area lost= superior division of MCA stroke
14
Q

What artery has had a stroke if the pt experiences hemispacial neglect, tactile extinction (can feel touch on both sides but not recognise touch on right if touched on both sides at once), visual extinction and anosognosia (deny having disability)?

A

Right MCA- less likely to get aphasias and motor/ sensory losses as these generally controlled by left hemisphere

15
Q

What stroke is most likely to cause a contralateral homonymous hemianopia with macula sparing?

A

Posterior cerebral artery stroke (deep branches of MCA supply macula region)

16
Q

Describe the possible signs and symptoms seen with a distal cerebellar artery stroke?

A

dysdiadochokinesis, ataxia, nystagmus, intention tremour, slurred speech, hypotonia

17
Q

Describe other than cerebellar signs, what may be affected in proximal cerebellar artery strokes?

A

Brain stem effected:

  • ipsilateral cranial nerve lesions: CNIII-> XII
  • contralateral motor and sensory loss in all modalities (all ascending and descending fibres have decussated at or before the medulla)
18
Q

What type of stroke may cause bilateral blindness?

A

A basilar artery stroke occluding both posterior cerebellar arteries

19
Q

Other than blindness, name 3 other effects basilar artery strokes could have?

A
  • occlusion of both superior cerebellar arteries leading to bilateral midbrain and cerebellar signs
  • bilateral pontine artery occlusion leading to locked in syndrome (CNI-IV + cerebrum, reticular formation and ascending sensory info but all motor functions other than eyes lost)
  • Bilateral anaesthesia due to thalamic infarction (supplied by deep branches of PCA)
20
Q

What is a lacunar stroke?

A

Stroke of small penetrating arteries- eg lenticulostriate arteries, thalamoperforatory artery, basilar artery perforators

21
Q

Occlusion of which vessel will lead to a contralateral hemiparesis (paralysis of one side of body, UMN signs)

A

Lenticulostriate arteries (branch off MCA)- as supply internal capsule.

22
Q

Occlusion of which blood vessel will lead to a pure contralateral sensory loss of all modalities on one side of the body?

A

Thalamoperforator artery- branch of PCA which goes to thalamus

23
Q

Name 4 lacunar stroke syndromes?

A

pure motor, pure sensory, mixed motor and sensory (lenticulostriate artery stroke), ataxic hemiparesis (lenticulostriate artery), clumsy hand dysarthria (basilar artery perforators)