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Stroke

November 24, 2016


Stroke should be suspected in anyone presenting with an acute onset, ongoing focal neurological deficit that cannot be explained by hypoglycaemia or other stroke mimics.

Stroke is defined as a clinical syndrome, caused by cerebral infarction (85% of cases) or haemorrhage (15% of cases), characterised by rapidly developing signs of focal and global disturbance of cerebral functions lasting more than 24 hours or leading to death.

Stroke Territories

Blood Vessel Affected Structures supplied Clinical Features
Anterior cerebral artery Frontal lobe Contralateral leg weakness, Contralateral sensory loss, Behavioural abnormalities, Personality change, Urinary incontinence
Middle cerebral artery Frontal lobe, Temporal lobe, Parietal lobe, Basal ganglia and Internal capsule Contralateral hemiplegia (face/arm > leg), Contralateral sensory loss, Expressive or receptive dysphasia (if dominant lobe), Contralateral neglect (if non-dominant lobe)
Posterior cerebral artery Temporal lobe, Occipital lobe Contralateral homonymous hemianopia
Vertebral-basilar arteries Cerebellum, Brainstem Cerebellum: Dysdiadochokinesia, ataxia, nystagmus, intention tremor, slurred speech, hypotonia (DANISH)

Brainstem:Hemiparesis/quadriplegia, sensory loss, diplopia, dysconjugate gaze, slurred speech, dysphagia, decreased consciousness, abnormal respiration

Functional Anatomy of the Brain

stroke

Image modified by FRCEM Success. Original image by OpenStax College [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons.

Cerebral Circulation

vasc

Image modified by FRCEM Success. Original image by derivative work: Frank Gaillard (talk) Brain_stem_normal_human.svg: Patrick J. Lynch, medical illustrator (Brain_stem_normal_human.svg) [GFDL 1.3 (www.gnu.org/licenses/fdl-1.3.html), GFDL 1.3 (www.gnu.org/licenses/fdl-1.3.html), CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or CC BY 2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons.

Middle Cerebral Artery Ischaemic Stroke

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Image by Rhcastilhos (Gray519.png) [Public domain], via Wikimedia Commons.

Image by Lucien Monfils derivative work: Suraj (INFARCT.jpg) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons.

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