Podcast
Questions and Answers
What is the most common type of stroke and its primary characteristic?
What is the most common type of stroke and its primary characteristic?
Which cerebral artery is primarily responsible for sensory and motor function in the lower limb?
Which cerebral artery is primarily responsible for sensory and motor function in the lower limb?
In a left-sided stroke affecting the motor cortex, what speech-related symptom is most likely to occur?
In a left-sided stroke affecting the motor cortex, what speech-related symptom is most likely to occur?
What observation would be expected from a patient experiencing a right-sided MCA stroke?
What observation would be expected from a patient experiencing a right-sided MCA stroke?
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What is a common test used to evaluate a patient for a suspected stroke?
What is a common test used to evaluate a patient for a suspected stroke?
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A patient presents with right-sided weakness, facial droop, and difficulty speaking. Which of the following is the most likely location of the stroke?
A patient presents with right-sided weakness, facial droop, and difficulty speaking. Which of the following is the most likely location of the stroke?
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A patient with a stroke affecting the left ACA presents with paralysis of the right leg. Which of the following additional findings is most likely in this patient?
A patient with a stroke affecting the left ACA presents with paralysis of the right leg. Which of the following additional findings is most likely in this patient?
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A patient with a right PCA stroke is most likely to present with which of the following symptoms?
A patient with a right PCA stroke is most likely to present with which of the following symptoms?
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A patient presents with right-sided facial weakness, but normal movement of the right upper face. Which of the following is the most likely explanation?
A patient presents with right-sided facial weakness, but normal movement of the right upper face. Which of the following is the most likely explanation?
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Which of the following is the most likely diagnosis for a patient presenting with acute vision loss on the left side and hallucinations of people not present in the room?
Which of the following is the most likely diagnosis for a patient presenting with acute vision loss on the left side and hallucinations of people not present in the room?
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A patient presents with a left-sided stroke. Which of the following symptoms is MOST likely to occur?
A patient presents with a left-sided stroke. Which of the following symptoms is MOST likely to occur?
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A patient presents with right-sided facial weakness, but normal movement of the right upper face. What is the most likely explanation?
A patient presents with right-sided facial weakness, but normal movement of the right upper face. What is the most likely explanation?
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A patient presents with sudden onset of right-sided weakness, facial droop, and speech difficulty. Where is the stroke likely located?
A patient presents with sudden onset of right-sided weakness, facial droop, and speech difficulty. Where is the stroke likely located?
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A patient with a stroke presents with a homonymous hemianopia (loss of vision in the same half of both visual fields). Which of the following is the most likely location of the stroke?
A patient with a stroke presents with a homonymous hemianopia (loss of vision in the same half of both visual fields). Which of the following is the most likely location of the stroke?
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A stroke affecting the internal capsule would most likely cause which of the following symptoms?
A stroke affecting the internal capsule would most likely cause which of the following symptoms?
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Flashcards
Ischemic Stroke
Ischemic Stroke
A type of stroke caused by insufficient blood flow, often due to thrombosis or embolism.
Hemorrhagic Stroke
Hemorrhagic Stroke
A type of stroke characterized by bleeding in the brain, leading to sudden onset symptoms.
MCA Function
MCA Function
The middle cerebral artery controls movement and sensation of the upper limb and face.
ACA Stroke Symptoms
ACA Stroke Symptoms
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Visual Field Deficits
Visual Field Deficits
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Common Stroke Site Symptoms
Common Stroke Site Symptoms
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Contralateral Symptoms
Contralateral Symptoms
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Upper vs Lower Face UMN Supply
Upper vs Lower Face UMN Supply
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Visual Symptoms of PCA Stroke
Visual Symptoms of PCA Stroke
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Signs of Left ACA Stroke
Signs of Left ACA Stroke
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Symptoms of MCA Stroke
Symptoms of MCA Stroke
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Signs of Right ACA Stroke
Signs of Right ACA Stroke
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Visual Field Loss in PCA Stroke
Visual Field Loss in PCA Stroke
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Upper vs Lower Face Function
Upper vs Lower Face Function
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Common Stroke Tests
Common Stroke Tests
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Study Notes
Cerebral and Lacunar Strokes
- Ischemic strokes account for 80% of cases, resulting from insufficient blood flow. Causes include thrombosis, embolism, and hypoperfusion. Symptoms typically appear over hours.
- Hemorrhagic strokes represent 20% and involve bleeding within the brain. Sudden onset is characteristic. Non-contrast CT of the head is the first recommended test.
CNS Blood Supply
- MCA (Middle Cerebral Artery): Supplies the upper limb, face, and the face.
- ACA (Anterior Cerebral Artery): Supplies the lower limb.
- PCA (Posterior Cerebral Artery): Supplies vision areas.
Homunculus
- Represents the motor and sensory areas in the brain, with detailed regions dedicated to different body parts.
- Different zones devoted to specific body parts.
- MCA supplies upper limb, face
- ACA supplies lower limb
- PCA supplies vision
MCA Stroke
- Most common stroke location.
- Signs include contralateral motor/sensory problems (arm weakness more pronounced than leg), facial drooping, drooling, difficulty speaking(aphasia), and hemiplegia (paralysis on one side).
- Left-sided strokes often cause aphasia.
- Right-sided strokes often cause hemi-neglect(inability to perceive the contralateral side of the body).
- The left MCA supplies the dominant language centre that can be affected by the left side stroke and cause aphasia.
Lower Facial Droop
- Upper face receives dual UMN (Upper Motor Neuron) input from both hemispheres; lower face input is primarily contralateral.
- In an MCA stroke that affects the lower face, the upper face isn't impacted
ACA Stroke
- Second most common site.
- Symptoms often include leg weakness, and impairment to sensation in the leg and hip, and potentially sensory loss in the leg.
- More common in the medial cortex.
PCA Stroke
- Posterior portion of the brain.
- Visual deficits (difficulty seeing on one side, visual hallucinations, unable to recognize objects despite seeing them) are typical symptoms. Macular sparing (limited or no vision loss in the central area of the visual field), however, is common.
- Can cause contralateral hemianopsia with macular sparing.
- Posterior cerebral artery occlusions can result in homonymous hemianopsia.
Homonymous Hemianopsia
- Visual loss is the same in both eyes(loss of the same side of the visual field in both eyes).
- This is frequently associated with PCA strokes.
Macular Sparing
- The macula, the central area of the retina responsible for detailed vision, often remains unaffected despite other visual field loss
- MCA and PCA provide separate blood supply, explaining the difference.
Thalamic Syndrome
- Characterized by contralateral sensory loss (face, arms, and legs), a proprioception deficit (loss of balance and coordination), and chronic pain on the opposite side of the injury. No motor impairment is a distinguishing feature.
Hypoxic Encephalopathy
- Results from lack of oxygen.
- Causes include shock, anemia, and repeated hypoglycemia..
- Can quickly result in coma
- Neurons lack glycogen, making them susceptible
- Hippocampus and cerebellum are particularly vulnerable.
- Damaged areas include the hippocampus first followed by the cerebellum.
- Rapid correction of sodium levels can also cause this.
Watershed Area Infarct
- Stroke occurring in the boundaries between main arteries.
- MCA, ACA, and PCA often impacted.
- Associated with massive stroke events.
- Weakness in areas supplied by the affected zones are common.
- Can present as "man-in-a-barrel" symptoms (weakness of the shoulders and thighs, with sparing of face, hands, and feet)
Lacunar Strokes
- Small strokes in noncortical areas.
- Different from strokes in larger arteries (MCA, ACA, PCA).
- Often associated with hypertension, diabetes, and smoking.
- "Cortical" signs of aphasia or hemianopsia are uncommon.
- Symptoms may be subtle/unnoticeable, often causing no clear deficit/loss
- Frequently located in internal capsule, thalamus, basal ganglia, and pons.
- Artery branches (lenticulostriate arteries, choroidal arteries, recurrent arteries of Heubner or thalamoperforate arteries and paramedian branches) are affected.
- Caused by arteriolar sclerosis (hypertension). Causes include lipohyalinosis; microatheromas.
- Usually resolves and leaves lacunae(small cavities) in the brain.
AICA Stroke
Symptoms are characteristic of a lateral pontine syndrome
- Symptoms likely include vertigo, nystagmus, nausea, and vomiting.
- Face pain/temperature loss on the ipsilateral (same side).
- Facial drooping and loss of corneal reflex (ophthalmic), and/or decreased sensation of one side of face
- Sympathetic tract also often implicated (Horner's syndrome).
- Taste and facial sensations/movement on the same side of the body are commonly affected.
- Hearing loss.
PICA Stroke
Lateral medullary syndrome.
- Presents with dizziness, vertigo, and nausea/vomiting
- Ipsilateral (same side) facial pain/temperature loss, and contralateral body pain/temperature loss
- Horner's Syndrome (sympathetic dysfunction).
- Hoarseness, dysphagia, and a reduced gag reflex (related to the nucleus ambiguus) are potential problems.
ASA Stroke
- Affects midline structures.
- Damage can impact medulla or spinal cord.
- Problems in the areas supplied by the affected arteries/zones are likely.
Central Pontine Myelinolysis
- Demyelination in the pons often due to quick shifts in body fluids (Na correction).
- Similar symptoms to locked-in syndrome (difficulty moving except blinking eyes)
- Quadriplegia (paralysis of all limbs).
- Caused by rapid shifts in electrolyte balance, usually sodium.
Top of the Basilar Syndrome
- Uncommon upper basilar artery occlusion (typically embolic in nature).
- Visual symptoms (including hallucinations, blindness), and 3rd nerve palsy are common symptoms.
- Vertical eye movement problems, issues with eye convergence, no typical motor loss.
Cerebral Aneurysms
- Weak vessel wall regions.
- Abnormal dilation.
- Saccular or berry aneurysms are a more common type, with locations frequent in the anterior circle of Willis.
Aneurysm Rupture
- Bleeding into the cerebrospinal fluid space (subarachnoid hemorrhage).
- Common causes include hypertension-induced issues.
- Severe headaches.
- Neurological issues are possible, but rare.
- Rebleeding is common.
Subarachnoid Hemorrhage
- Bleeding into the area between the arachnoid and pia mater.
- Often indicated by sudden severe headache.
- Cerebral aneurysms (commonly berry aneurysms) frequently are the cause, often occurring in the anterior circle of Willis regions.
- Neurological symptoms may or may not be obvious.
- Signs include "worst headache of one's life", and sudden onset symptoms.
Intracranial Bleeding
- Mass lesions/tumors
- Cerebral edema (trauma, stroke, and others): Hydrocephalus.
- Obstructions of venous outflow (thrombosis)
- Idiopathic intracranial hypertension
- Pseudotumor cerebri
- Other forms of intracranial bleeding that are not stroke-related
- Increased intracranial pressure (ICP) can cause herniation of brain regions.
Increased Intracranial Pressure
- Headaches
- Depressed consciousness/ altered LOC
- Pressure on vital structures in the brain
- Vomiting
- Papilledema
- Cushing's Triad: Hypertension, bradycardia, and abnormal respirations, indicate raised ICP
Papilledema
- Swelling of the optic disc caused by increased intracranial pressure.
- Often bilateral.
- Impaired vision.
- Impaired visual acuity.
Cushing's Triad
- Hypertension, bradycardia, and irregular breathing; can indicate higher intracranial pressures, and the presence of severe/rapidly rising intracranial pressure
Posturing
- Decorticate posturing (arms flexed). Cerebral Hemisphere Damage
- Decerebrate posturing (arms extended),Brainstem Damage
Glasgow Coma Scale
- Used to assess consciousness.
- Scores range from 3 to 15.
- Based on eye-opening, verbal response, and motor response.
Herniation
- Brain displacement due to expanding volumes (blood clots, tumors).
- Forces brain through weaker points. Locations include subfalcine, uncal, transtentorial, and tonsillar.
Epidural Hematoma
- Bleeding between dura and skull.
- Often traumatic (ruptured middle meningeal artery commonly in temporal bone).
- Convex shape on CT scans
- Lucid interval is frequently present
- Usually associated with a fracture in the temporal bone
Subdural Hematoma
- Bleeding between dura and arachnoid.
- Typically traumatic (ruptures of bridging veins within the dura, common in aged people or those with thinner brain tissue).
- Can cause confusion episodes later, weeks after injury.
- Slow onset symptoms.
- Crescent shaped.
- Follows head injury.
- Often associated with alcoholic or elderly individuals, as thinned structures are common.
- Risk factors include old age, alcohol use, and blood thinners.
- May cross suture lines.
- Limited by dural reflections(falx cerebri, tentorium, falx cerebelli).
Subarachnoid Hemorrhage
- Bleeding into the subarachnoid space between the arachnoid and pia mater.
- Typically caused by ruptured aneurysms in the brain.
- Neurological symptoms may or may not be obvious.
- Signs include "worst headache of one's life", and sudden onset symptoms.
- Xanthochromia (yellowing of CSF) on spinal tap, a distinctive sign, often present
- Commonly caused by ruptured berry aneurysms. Often located in the anterior circle of Willis.
- Frequently associated with underlying conditions (such as genetic disorders, marfan syndrome, and polycystic kidney disease).
Hemorrhagic Stroke
- Bleeding inside the brain tissue (intraparenchymal).
- Often caused by small arteries/arterioles rupturing, hypertension, anticoagulation issues, or malignancies
- Can also follow ischemic strokes, as impacted circulatory pathways are then prone to pressure and rupture.
Sites of Intraparenchymal Bleed
- Putamen: common stroke presentation.
- Subcortex
- Cerebellum.
- Thalamus.
- Pons: located frequently but is only 5-12% of hemorrhagic stroke cases
Charcot-Bouchard Aneurysms
- Small, frequently found in artery regions.
- Common in hypertension cases, due to damaged vessels that thin and expand.
- Can trigger hypertensive intracranial hemorrhages.
Cerebral Amyloid Angiopathy
- Beta-amyloid deposits in arteries.
- Usually lobar hemorrhages (frontal, parietal, occipital lobes).
- Recurrent hemorrhagic events.
- Common in older individuals.
Intraventricular Hemorrhage
- Bleeding into the brain ventricles.
- Often a complication in premature infants.
- Massive bleeds can cause symptoms like altered LOC (levels of consciousness), hypotonia, loss of movement.
- Clots can block fluid/blood flow pathways.
Key VB Stroke Syndromes
- AICA (superior cerebellar artery): lateral pons.
- PICA (posterior inferior cerebellar artery): lateral medulla
- ASA (anterior spinal artery): medial medulla, spinal cord
Additional Notes
- A "lucid interval" is a symptom of epidural hematomas.
- Several conditions may increase the risk of ruptured aneurysms/ bleeds, including diabetes, ADPKD, and genetic disorders.
- Symptoms consistent with stroke may include altered levels of consciousness, confusion, and weakness.
- Understanding the different types of strokes helps to determine the causes and treatment steps required.
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Description
This quiz explores the types of strokes, specifically ischemic and hemorrhagic strokes, and their characteristics. It covers the anatomy of cranial blood supply, including the roles of the MCA, ACA, and PCA, as well as the representation of body parts in the brain's homunculus. Test your understanding of stroke symptoms and implications for motor and sensory function.
