1 Stroke

Question 1

What is a stroke and what affects the neurological deficit?

Answer 1

• Sudden onset of focal neurological deficits fitting a vascular destribution
• Neurological deficit depends on location and extent of lesion

Question 2

What are some common neurological deficits from stroke?

Answer 2

• Impaired control over movement
• Impaired sensation/perception
• Impaired speech/language
• impaired contive function
• Visual field deficit

Question 3

What is an Ischemic Stroke?

Answer 3

• Obstructed blood vessesl (84%)
• Clot by thromus or embolis

Question 4

What are the two types of Ischemic stroke?

Answer 4

• Thombosis: Athersclerosis
• Embolism: DEtached mass carried by blood

Blockage deprives braina of oxygen and glucose: Infarction

Question 5

What is a Hemorrhagic stroke?

Answer 5

Occurs when weakned blood vessel wall ruptures (17%)

• Aneurysm and ateriovenous malformations (AVM)

Question 6

Describe a Transient Ischemic Attack (TIA)

Answer 6

• AKA Mini stroke (temporary block of artery)
• Acuose loss of focal function with sympotns < 24 hurs (usually 2 hr duration)
• due in inadequte cerebral circuation
• No permanent damage or disability
• From tiny emboli - break up and quickly dissolve
• WARNING SIGN: 30% of people with TIA have stroke within 5yrs

Question 7

Describe the onset of Thrombosis Stroke

Answer 7

• During night or after nap
  
  • headache + loss of motor/sensory in body
  • (thrombosis > embolus or hemorrhage

Question 8

Describe the onset of an Embolus stroke

Answer 8

• Occurs during ordinary activity - circulation more active (symptoms during daily activites)
  
  • Embolus > Hemorrage or thrombosis

Question 9

Describe the onset of a Hemorrhage stroke

Answer 9

Stress (exertion -cough, sneeze, valsalva)

Question 10

What is the Anterior Cerebral Artery?

Answer 10

ACA supplies medial part of the frontal lobe, parietal lobe

Anterior part of corpus collosum,, basal ganglia, internal capsule

Question 11

What is the middle cerebral artery?

Answer 11

• Supplies LATERAL surface of the hemisphere (not medial parts or inferior parts)

Question 12

What is the Posterior Cerebral Artery?

Answer 12

• Supply INFEROMEDIAL part of temporal lobe, occipital lobe, visual cortex, and splenium of corpus collosum

Question 13

Describe the ACA stroke

Answer 13

• Loss of:
• Motor function
  
  • CONTRALATERAL LE
• Somatosensory
  
  • CONTRALATERAL LE
• Cognitive: Executive funciton
  
  • Planning, motor, descision making, impulse control, selective attension

Affects ACA and Homunculus

Question 14

Describe the MCA Stroke

Answer 14

• Largest branch from ICA
• Loss of:
• Motor:
  
  • CONTRALATERAL LOWER FACE, ARM, some trunk
• Somatosensation:
  
  • CONTRALATERAL FACE, ARM, some trunk
• Vision:
  
  • HOMONYMOUS HEMIANOPSIA
• Dominant Hemisphere:
  
  • L - Motor speech, speech reception, reading, writing, calculating
• Non Dom Hemisphere:
  
  • Hemineglect, agnosia

Question 15

Describe a PCA stroke

Answer 15

• CONTRALATERAL visual field defect
• ex) L infarction = Acute loss in R half of visual field

Question 16

Describe the Rule of 4’s for Brainstem stroke (location)

Answer 16

• 4 CN in each section (not 1-2)
• CN divisible by 12 are MIDLINE OR MEDIAL
  
  • 3 4 6 12 = MOTOR ONLY
• Not divisible by 12 are LATERAL
  
  • 5 7 8 9 10 = Sensory (11 is lateral)

Question 17

Describe the rule of 4’s for Motor Syndromes

Answer 17

• Midline
  
  • Medial longitudial fasiculus (eye)
  • Motor tracts of UMN (corticospinal)
  • Medial Lemniscus (proprioception, vibration)
  • Motor nuclei of CN

Question 18

Describe Rule of 4 Sensory syndromes

Answer 18

• SIDE (LATERAL)
  
  • Spinothalamic (pain temp)
  • Spinocerebellar (RAM)
  • Sympathetic chain (Dilation, sweating, etc)
  • Sensory CN nuclei

Question 19

Which CN are in the Midbrain Pons and Medulla?

Answer 19

• Midbrain: 3 4
• Pons 5 7 8 (lateral), 6 (medial)
• Medulla: 9 10 11 (lateral), 12 (medial)