Stroke

Question 1

Stroke

Answer 1

An episode of sudden neurologic dysfunction caused by interruption of blood flow to a part of the brain (ischemia), leading to brain cell death (infarction) regardless of symptom duration

Question 2

Common symptoms of a stroke

Answer 2

-Hemiparesis (weakness on one side of the body)
-Dysarthia (difficulty articulating speech)
-Sensory deficits (one side of the body)
-Aphasia
-Visual deficits

Question 3

Transient ischemic stroke (TIA)

Answer 3

A temporary episode of neurologic dysfunction due to a brief interruption of blood flow to the brain, spinal cord, or retina w/o permanent brain injury

Question 4

Risk of stroke after a TIA

Answer 4

Having a TIA increases the risk of developing an ischemic stroke, especially in the first 48 hours

Question 5

Factors that increase the risk of a stroke after a TIA (ABCDD)

Answer 5

-Age: >60
-BP: systolic 140+ or diastolic 90+
-Clinical features of TIA: unilateral weakness and/or speech impairment
-Duration of TIA: 60+ mins is higher risk than 10-59 mins
-Diabetes

Question 6

Treatment of TIA

Answer 6

Initial: dual antiplatelets for 3 weeks
*Urgent CT/CTA for head and neck
Long term: single antiplatelet with high dose statin

Question 7

Divisions of the internal carotid artery (4)

Answer 7

-Cervical
-Petrous
-Cavernous (C4 + C5)
-Carotid siphon (C3) - technically not a “divison”
-Cerebral part (C1 and C2)

Question 8

Branches of the internal carotid artery (5)

Answer 8

-Ophthalmic artery
-Anterior choroidal artery
-Anterior cerebral artery
-Middle cerebral artery
-Posterior communicating artery

Question 9

Anterior choroidal artery lesion features

Answer 9

-Hemiplegia (paralysis on one side of the body)
-Hemianesthesia (loss of sensation on one side of the body)
-Sector-sparing homonymous hemianopsia (small sector of the visual field on the affected site is spared)

Question 10

Anterior cerebral artery lesion features

Answer 10

-Contralateral weakness (leg > arm)
-Abulia (lack of will/initiative)
-Akinetic mutism (patient is alert but doesn’t move or speak spontaneously)
-Paratonia (resistance to passive movement)
-Urinary continence

Question 11

Middle cerebral artery lesion features

Answer 11

-Contralateral weakness
-Aphasia (if infarct on the left)
-Neglect (if infarct on thr right)

Question 12

Posterior cerebral artery lesion features

Answer 12

-Alexia w/o agraphia (can write but can’t read)

Question 13

Anton’s synrome

Answer 13

-Cause: bilateral occipital lobe infarcts (in PCA territory)
-Result: cortical blindness (loss of vision), confabulation (making up visual descriptions)

Question 14

Balint’s syndrome

Answer 14

-Cause: bilateral parietal-occipital infarcts (from PCA strokes)
-Result: oculomotor apraxia (difficulty voluntarily directing gaze towards objects), optic ataxia (inability to reach for objects under visual guidance), simultanagnosia (can only perceive one object at a time)