17- Trouma & ER Explains Flashcards
When should heparin be given in the management of pulmonary embolism?
Heparin should be given if there is an intermediate or high clinical probability before imaging.
What are the considerations for using unfractionated heparin (UFH)?
Unfractionated heparin (UFH) should be considered as a first dose bolus, in cases of massive pulmonary embolism, or when rapid reversal of effect may be needed.
What is the target INR range for anticoagulation?
The target INR (international normalized ratio) range for anticoagulation is 2.0-3.0. Once this range is achieved, heparin can be discontinued.
When should oral anticoagulation be commenced?
Oral anticoagulation should only be commenced once venous thromboembolism (VTE) has been reliably confirmed.
What is the preferred anticoagulant over UFH in most cases?
In most cases, low molecular weight heparin (LMWH) is considered preferable to UFH. It has equal efficacy and safety and is easier to use.
What is the standard duration of oral anticoagulation for pulmonary embolism?
The standard duration of oral anticoagulation is 4 to 6 weeks for temporary risk factors, 3 months for the first idiopathic case, and at least 6 months for other cases. The risk of bleeding should be balanced with the risk of further VTE.
How is clinically massive pulmonary embolism diagnosed?
Clinically massive pulmonary embolism can be reliably diagnosed using CTPA (computed tomography pulmonary angiography) or echocardiography.
What is the first-line treatment for massive pulmonary embolism?
Thrombolysis is the first-line treatment for massive pulmonary embolism, especially in cases of circulatory failure. It may be instituted based on clinical grounds alone if cardiac arrest is imminent. A recommended dose is a 50 mg bolus of alteplase.
When should invasive approaches like thrombus fragmentation and IVC filter insertion be considered?
Invasive approaches like thrombus fragmentation and IVC (inferior vena cava) filter insertion should be considered when facilities and expertise are readily available.
What are some predisposing factors for aortic dissection in pregnancy?
Predisposing factors for aortic dissection in pregnancy include hypertension, congenital heart disease, and Marfan’s syndrome.
What type of aortic dissections are mainly seen in pregnancy?
Mainly Stanford type A dissections are seen in pregnancy.
What are some symptoms of aortic dissection in pregnancy?
Symptoms of aortic dissection in pregnancy include sudden tearing chest pain, transient syncope (fainting), feeling cold and clammy, hypertension, and an aortic regurgitation murmur.
What may happen if the right coronary artery is involved in aortic dissection?
Involvement of the right coronary artery may cause an inferior myocardial infarction.
What is the most common cause of mitral stenosis in pregnancy?
Most cases of mitral stenosis in pregnancy are associated with rheumatic heart disease.
What is the surgical management for aortic dissection based on the gestational timeframe?
For aortic dissections before 28 weeks of pregnancy, aortic repair is performed with the fetus kept in utero. Between 28 and 32 weeks, it depends on the fetal condition. After 32 weeks, a primary cesarean section is followed by aortic repair during the same operation.
Is mitral stenosis becoming more or less common in British women?
Mitral stenosis is becoming less common in British women.
What is the most common cardiac condition seen in pregnancy?
The most common cardiac condition seen in pregnancy is mitral stenosis.
What is the preferred treatment for mitral stenosis?
Valve surgery, specifically balloon valvuloplasty, is preferred for the treatment of mitral stenosis.
What is the leading cause of mortality in pregnancy?
Pulmonary embolism is the leading cause of mortality in pregnancy.
What is the recommended treatment for pulmonary embolism during pregnancy?
Treatment with low molecular weight heparin is recommended throughout pregnancy and 4-6 weeks after childbirth for pulmonary embolism.
What imaging tests are used to aid in the diagnosis of pulmonary embolism?
Half dose scintigraphy is used initially, and a CT chest may be performed if there is underlying lung disease to aid in the diagnosis of pulmonary embolism.
Is warfarin safe to use during pregnancy?
Warfarin is contraindicated in pregnancy, but it may be continued in women with mechanical heart valves due to the significant risk of thromboembolism.
What percentage of blunt chest trauma requires operative intervention?
Less than 10% of blunt chest trauma requires operative intervention.
What are the physiologic consequences of thoracic trauma?
The physiologic consequences of thoracic trauma are hypoxia, hypercarbia, and acidosis.
What can cause hypoxia in thoracic trauma?
Contusion, hematoma, alveolar collapse, or changes in intrathoracic pressure relationships (such as tension pneumothorax and open pneumothorax) can cause hypoxia in thoracic trauma.
What is a tension pneumothorax?
A tension pneumothorax is often a laceration to the lung parenchyma with a flap, causing pressure to develop in the thorax. The most common cause is mechanical ventilation in a patient with pleural injury.
What can cause respiratory acidosis in thoracic trauma?
Hypercarbia, which is caused by inadequate ventilation due to changes in intrathoracic pressure relationships and a depressed level of consciousness, can cause respiratory acidosis in thoracic trauma.
What are the symptoms of tension pneumothorax?
Symptoms of tension pneumothorax overlap with cardiac tamponade, but a hyper-resonant percussion note is more likely in tension pneumothorax.
What is flail chest?
Flail chest occurs when the chest wall disconnects from the thoracic cage. It is characterized by multiple rib fractures (at least two fractures per rib in at least two ribs) and is associated with pulmonary contusion.
What precautions should be taken with flail chest patients?
It is important to avoid overhydration and fluid overload in patients with flail chest.
What is the most common cause of pneumothorax in thoracic trauma?
The most common cause of pneumothorax in thoracic trauma is lung laceration with air leakage.
When should a chest drain be inserted in patients with traumatic pneumothorax?
Patients with traumatic pneumothorax should never be mechanically ventilated until a chest drain is inserted.
What is the most common cause of haemothorax in thoracic trauma?
Haemothorax in thoracic trauma is most commonly due to laceration of the lung, intercostal vessel, or internal mammary artery.
When is surgical exploration warranted in cases of haemothorax?
Surgical exploration is warranted if there is an immediate drainage of more than 1500ml of blood.
How should large haemothoraces be treated?
Large haemothoraces that are visible on a chest X-ray should be treated with a large bore chest drain.
What are the characteristics of cardiac tamponade?
Cardiac tamponade is characterized by Beck’s triad (elevated venous pressure, reduced arterial pressure, reduced heart sounds) and pulsus paradoxus. It may occur with as little as 100ml of blood.
What is the most common potentially lethal chest injury?
Pulmonary contusion is the most common potentially lethal chest injury.
What are the important diagnostic tools for pulmonary contusion?
Arterial blood gases and pulse oximetry are important diagnostic tools for pulmonary contusion.
When should early intubation be considered in cases of pulmonary contusion?
Early intubation within an hour should be considered if there is significant hypoxia in cases of pulmonary contusion.
What usually causes blunt cardiac injury?
Blunt cardiac injury usually occurs as a secondary injury to chest wall injury.
What features may be seen on an ECG in blunt cardiac injury?
An ECG may show features of myocardial infarction in blunt cardiac injury.
What are some sequelae of blunt cardiac injury?
Sequelae of blunt cardiac injury include hypotension, arrhythmias, and cardiac wall motion abnormalities.
What are some common causes of diaphragm disruption?
Most cases of diaphragm disruption are due to motor vehicle accidents and blunt trauma, causing large radial tears.
What should be done in cases of diaphragm disruption?
In cases of diaphragm disruption, it is important to insert a gastric tube, as it may pass into the intrathoracic stomach.
Which side is diaphragm disruption more common on?
Diaphragm disruption is more commonly seen on the left side.
What suggests a great vessel injury in mediastinal traversing wounds?
The presence of a mediastinal hematoma or pleural cap suggests a great vessel injury
What does mediastinal traversing wounds refer to?
Mediastinal traversing wounds refer to cases where there is an entrance wound in one hemithorax and an exit wound or foreign body in the opposite hemithorax.
What is the sensitivity of FAST scanning in pregnancy?
The sensitivity of FAST scanning is reduced in pregnancy, especially with advanced gestational age. It ranges from 60-80% across all trimesters and is 90% in the first trimester.
What are the advantages of sonography and FAST scanning in pregnant trauma patients?
Sonography and FAST scanning in pregnant trauma patients have the advantage of avoiding ionising radiation.
What is the mortality rate of mediastinal traversing wounds?
The mortality rate of mediastinal traversing wounds is 20%.
What is the recommended first-line investigation in major trauma cases in pregnant patients?
CT scanning remains the first-line investigation in major trauma cases where significant visceral injury is suspected.
Does a pelvic CT scan fall below the maximum safe dose of radiation in pregnancy?
Yes, a pelvic CT scan would fall below the maximum safe dose of radiation in pregnancy.
What is the maximum safe dose of radiation in pregnancy?
The maximum permitted safe dose of radiation in pregnancy is 5mSv.
What are the risks of radiation exposure in pregnancy?
Early exposure to radiation increases the risk of developmental anomalies and fetal loss, while late exposure increases the risk of childhood cancer twofold.
What is the most sensitive test for identifying complications such as placental abruption in pregnant trauma patients?
CT scanning remains the most sensitive test for identifying complications such as placental abruption in pregnant trauma patients.
How should patients with head injuries be managed?
Patients with head injuries should be managed according to ATLS principles, and extra cranial injuries should be managed alongside cranial trauma.
What can compromise CNS perfusion regardless of the nature of the cranial injury?
Inadequate cardiac output can compromise CNS perfusion regardless of the nature of the cranial injury.
Where do the majority of extradural hematomas occur?
The majority of extradural hematomas occur in the temporal region where skull fractures cause a rupture of the middle meningeal artery.
What is an extradural hematoma?
An extradural hematoma is bleeding into the space between the dura mater and the skull. It often results from acceleration-deceleration trauma or a blow to the side of the head.
What are the features of an extradural hematoma?
Features of an extradural hematoma include raised intracranial pressure and some patients may exhibit a lucid interval.
What is a subdural hematoma?
A subdural hematoma is bleeding into the outermost meningeal layer. It most commonly occurs around the frontal and parietal lobes and may be either acute or chronic.
What are the risk factors for a subdural hematoma?
Risk factors for a subdural hematoma include old age and alcoholism.
What is the onset of symptoms like for a subdural hematoma compared to an extradural hematoma?
The onset of symptoms for a subdural hematoma is slower than that of an extradural hematoma.
What is a subarachnoid hemorrhage?
A subarachnoid hemorrhage usually occurs spontaneously in the context of a ruptured cerebral aneurysm but may also be seen in association with other injuries in a traumatic brain injury.
What are the types of primary brain injury?
Primary brain injury can be focal (contusion/hematoma) or diffuse (diffuse axonal injury).
What can exacerbate the original injury and cause secondary brain injury?
Cerebral edema, ischemia, infection, tonsillar or tentorial herniation can exacerbate the original injury and cause secondary brain injury.
What is diffuse axonal injury?
Diffuse axonal injury occurs as a result of mechanical shearing following deceleration, causing disruption and tearing of axons.
What happens to the brain’s auto regulatory processes following trauma?
Following trauma, the brain’s normal cerebral auto regulatory processes are disrupted, rendering the brain more susceptible to blood flow changes and hypoxia.
What is the management for life-threatening rising intracranial pressure?
In cases of life-threatening rising intracranial pressure, such as extradural hematoma, the use of IV mannitol/frusemide may be required while theatre is prepared or transfer is arranged.
What is the Cushings reflex and when does it often occur?
The Cushings reflex, characterized by hypertension and bradycardia, often occurs late and is usually a pre-terminal event.
What may diffuse cerebral edema require?
Diffuse cerebral edema may require decompressive craniotomy.
What is the management for open depressed skull fractures?
Open depressed skull fractures require formal surgical reduction and debridement, while closed injuries may be managed non-operatively if there is minimal displacement.
When is ICP monitoring appropriate in head injuries?
ICP monitoring is appropriate in patients with a GCS score of 3-8 and a normal CT scan.
When is ICP monitoring mandatory in head injuries?
ICP monitoring is mandatory in patients with a GCS score of 3-8 and an abnormal CT scan.
What is the most likely cause of hyponatremia in head injuries?
Hyponatremia is most likely to be due to the syndrome of inappropriate ADH secretion.
What is the minimum cerebral perfusion pressure in adults?
The minimum cerebral perfusion pressure in adults is 70mmHg.
What is the minimum cerebral perfusion pressure in children?
The minimum cerebral perfusion pressure in children is between 40 and 70 mmHg.
How can pupillary findings be interpreted in head injuries?
Pupil size and light response can help interpret pupillary findings in head injuries.
What does unilaterally dilated pupil with sluggish or fixed light response indicate?
Unilaterally dilated pupil with sluggish or fixed light response indicates 3rd nerve compression secondary to tentorial herniation.
What does bilaterally dilated pupil with sluggish or fixed light response indicate?
Bilaterally dilated pupils with sluggish or fixed light response indicate poor CNS perfusion or bilateral 3rd nerve palsy.
What does unilaterally dilated pupilor equal pupil size with a cross reactive (Marcus-Gunn) light response indicate?
Unilaterally dilated pupil or equal pupil size with a cross-reactive (Marcus-Gunn) light response indicates optic nerve injury.
What does bilaterally constricted pupil indicate?
Bilaterally constricted pupil may be difficult to assess, but it can be associated with opiate use, pontine lesions, or metabolic encephalopathy.
What does unilaterally constricted pupil indicate?
Unilaterally constricted pupil with preserved light response indicates sympathetic pathway disruption.
What are the three types of burns?
Thermal, chemical, and electrical.
What is the immediate management for burns?
Remove the burning source and irrigate the burned area.
What needs to be assessed after a burn?
The extent of the burns, which can be recorded using various charts.
How does the degree of injury relate to burns?
The degree of injury relates to the temperature and duration of exposure.
What are most domestic burns in young children?
Most domestic burns in young children are scalds.
What is a common complication of large burns?
Immunosuppression and bacterial translocation from the gut lumen.
What are the local and systemic responses to burns?
Locally, there is progressive tissue loss and release of inflammatory cytokines. Systemically, there are cardiovascular effects, fluid loss, sequestration of fluid, and a catabolic response.
What is a common cause of death following major burns?
Sepsis.
What is the management for each type of burn?
Epidermal/superficial burns normally heal with no intervention, superficial partial thickness burns may need surgical intervention, deep partial thickness burns require surgical intervention, and full thickness burns require transfer to a burns center.
What are the types of burns based on skin layers affected and appearance?
Epidermal/superficial, superficial partial thickness, deep partial thickness, and full thickness.
How can the depth of burns be assessed?
By checking for bleeding on needle prick, sensation, appearance, and blanching to pressure.
What are the methods for estimating percentage burn?
Lund Browder chart (most accurate), Wallace rule of nines, and palmar surface (0.8% burn for each palm).
When should a patient with burns be transferred to a burn center?
If they require burn shock resuscitation, have face/hand/genital burns, deep partial thickness or full thickness burns, or significant electrical/chemical burns.
What is the initial aim in managing burns?
To stop the burning process and resuscitate the patient.
What is the fluid resuscitation calculation for burns?
Volume of fluid = total body surface area of the burn % x weight (Kg) x 2-4 (preference for lower amount). Half of the fluid is administered in the first 8 hours.
What should be done for circumferential burns affecting a limb or severe torso burns?
Escharotomy may be required to divide the burnt tissue.
What is the management for superficial burns and mixed superficial burns that will heal in 2 weeks?
Conservative management.
What may be required for more complex burns?
Excision and skin grafting.
Is excision and primary closure generally practiced for burns?
No, as there is a high risk of infection.
Is antimicrobial prophylaxis or topical antibiotics recommended for burn patients?
No, there is no evidence to support their use.
When are escharotomies indicated?
Escharotomies are indicated in circumferential full thickness burns to the torso or limbs. They can improve ventilation or relieve compartment syndrome and edema.
When are intravenous fluids required for children and adults with burns?
Children with burns greater than 10% of total body surface area and adults with burns greater than 15% of total body surface area.
What should be done after fluid resuscitation for burns?
Insert a urinary catheter and provide analgesia.
What is the mechanism of injury for thoracic aorta rupture?
Decelerating force, such as a road traffic accident or fall from a great height.
What is the outcome for most people with thoracic aorta rupture?
Most people die at the scene.
What may survivors of thoracic aorta rupture have?
Survivors may have an incomplete laceration at the ligamentum arteriosum of the aorta.
What are the clinical features of thoracic aorta rupture?
Persistent hypotension caused by a contained hematoma.
How is thoracic aorta rupture detected?
It is mainly detected by history and changes seen on chest X-ray (CXR).
What changes can be seen on CXR for thoracic aorta rupture?
Widened mediastinum, trachea/esophagus shift to the right, depression of the left main stem bronchus, widened paratracheal stripe/paraspinal interfaces, obliteration of space between aorta and pulmonary artery, and rib fracture/left haemothorax.
What is the preferred diagnostic test for thoracic aorta rupture?
Angiography, usually CT aortogram.
What is the treatment for thoracic aorta rupture?
Repair or replacement. Ideally, the patient should undergo endovascular repair.
What are the clinical features of thoracic aorta dissection?
Tearing interscapular pain and a discrepancy in arterial blood pressures taken in both arms. It may also show mediastinal widening on chest X-ray.
What is diffuse esophageal spasm?
It is a spectrum of esophageal motility disorders characterized by uncoordinated contractions of the esophageal muscles.
What may be seen on a barium swallow for diffuse esophageal spasm?
It may show “nutcracker esophagus.”
What is a common cause of retrosternal discomfort?
Gastro-esophageal reflux is a common cause of retrosternal discomfort.
What are the symptoms of diffuse esophageal spasm?
Symptoms include dysphagia, retrosternal discomfort, and dyspepsia.
What are the associated symptoms of gastro-esophageal reflux?
Associated symptoms include regurgitation, odynophagia, and dyspepsia.
How are the symptoms of gastro-esophageal reflux usually managed?
Symptoms are usually well controlled with proton pump inhibitor (PPI) therapy.
What is Boerhaave’s syndrome?
It is the spontaneous rupture of the esophagus, often caused by episodes of repeated vomiting, usually associated with alcohol excess.
What are the typical symptoms of Boerhaave’s syndrome?
There is usually an episode of repetitive vomiting followed by severe chest and epigastric pain.
How is Boerhaave’s syndrome diagnosed?
It is diagnosed by CT and contrast studies.
What is the treatment for Boerhaave’s syndrome?
Treatment is surgical, with primary repair during the first 12 hours. Beyond this, the usual approach is creation of a controlled fistula with a T Tube. Delay beyond 24 hours is associated with fulminant mediastinitis and is usually fatal.
What is achalasia?
Achalasia is a condition characterized by difficulty swallowing (dysphagia) to both liquids and solids, and sometimes chest pain.
What is the most common cause of achalasia?
It is usually caused by the failure of distal esophageal inhibitory neurons.
How is achalasia diagnosed?
Diagnosis is made through pH and manometry studies, as well as contrast swallow and endoscopy.
What are the treatment options for achalasia?
Treatment options include botulinum toxin injection, pneumatic dilatation, or cardiomyotomy.
What are the two main causes of local anesthetic toxicity?
Toxicity can result from accidental intravascular injection or excessive dosage.
What effects do local anesthetic agents have on the body?
Local anesthetic agents not only stabilize peripheral nerves but also act on excitable membranes within the central nervous system (CNS) and heart.
Which type of neurons in the CNS are suppressed first?
Sensory neurons in the CNS are suppressed before motor neurons.
What are the early symptoms of local anesthetic toxicity?
The early symptoms are typically circumoral paraesthesia (tingling around the mouth) and tinnitus (ringing in the ears), followed by a decrease in the Glasgow Coma Scale (GCS) and eventually coma.
What are the steps in managing local anesthetic toxicity?
Stop injecting the anesthetic agent, administer high-flow 100% oxygen via a face mask, monitor cardiovascular function, administer lipid emulsion (Intralipid 20%) as a bolus, consider lipid emulsion infusion, and if toxicity is due to prilocaine, administer methylene blue.
What is the safe dose of lignocaine (lidocaine) 1%?
A 10ml solution of lignocaine 1% contains 100mg of the drug. In a 50kg patient, 70% of the maximum safe dose would be constituted by this amount. Up to 7mg/kg can be administered if adrenaline is added to the solution.
What are the recommended doses of local anesthetics?
For lignocaine: 3mg/kg plain, 7mg/kg with adrenaline. For bupivacaine: 2mg/kg plain, 2mg/kg with adrenaline. For prilocaine: 6mg/kg plain, 9mg/kg with adrenaline. These doses are a guide and may vary depending on the site of administration, tissue vascularity, and co-morbidities.
What are the options for eye opening in the Glasgow Coma Scale?
Spontaneous, to speech, to pain, or none.
What are the options for verbal response in the Glasgow Coma Scale?
Orientated, confused, words, sounds, or none.
What are the options for motor response in the Glasgow Coma Scale?
Obeys commands, localizes to pain, withdraws from pain, abnormal flexion to pain (decorticate posture), extending to pain, or none.
What GCS score is generally associated with severe brain injuries?
Severe brain injuries are generally associated with a Glasgow Coma Scale score of less than 8.
breakdown of the GCS scoring:
Eye-Opening Response:
Spontaneous: 4
To speech: 3
To pain: 2
None: 1
Verbal Response:
Oriented: 5
Confused conversation: 4
Inappropriate words: 3
Incomprehensible sounds: 2
None: 1
Motor Response:
Obeys commands: 6
Localizes pain: 5
Withdraws from pain: 4
Abnormal flexion (decorticate posturing): 3
Extensor response (decerebrate posturing): 2
None: 1
What is sick euthyroid syndrome?
Sick euthyroid syndrome, now referred to as non-thyroidal illness, is a condition in which thyroid hormone levels are altered due to systemic illness.
What factors determine the management of splenic trauma?
The management of splenic trauma is dictated by associated injuries, hemodynamic status, and the extent of direct splenic injury.
What is the typical pattern of hormone levels in sick euthyroid syndrome?
While it is often said that TSH, thyroxine (T4), and triiodothyronine (T3) are low in sick euthyroid syndrome, in the majority of cases, the TSH level is within the normal range. This is considered inappropriately normal given the low levels of thyroxine and T3.
Are the changes in hormone levels reversible?
Yes, the changes in hormone levels seen in sick euthyroid syndrome are reversible upon recovery from the systemic illness.
What are the management options for splenic trauma?
The management options for splenic trauma include conservative management, laparotomy with conservation, resection, and splenectomy.
What are the indications for conservative management in splenic trauma?
Conservative management is indicated for small subcapsular hematoma, minimal intra-abdominal blood, and no hilar disruption.
When is laparotomy with conservation performed in splenic trauma?
Laparotomy with conservation is performed when there are increased amounts of intra-abdominal blood, moderate hemodynamic compromise, and tears or lacerations affecting less than 50% of the spleen.
When is resection performed in splenic trauma?
Resection is performed for hilar injuries, major hemorrhage, and major associated injuries.
What post-operative care is required after splenectomy?
Post-operatively, the patient will require prophylactic penicillin V and pneumococcal vaccine.
What is the technique for splenectomy in splenic trauma?
The technique for splenectomy involves making a long midline incision, inserting a self-retaining retractor if time permits, packing all four quadrants of the abdomen, assessing the viability of the spleen, dividing and ligating the short gastric vessels, clamping the splenic artery and vein, being careful not to damage the tail of the pancreas, washing out the abdomen, placing a tube drain to the splenic bed, and considering implanting a portion of the spleen into the omentum.
What are some complications of splenectomy in splenic trauma?
Complications of splenectomy in splenic trauma can include hemorrhage, pancreatic fistula, thrombocytosis, and encapsulated bacteria infection.
What is the difference between emergency and elective splenectomy?
Emergency splenectomy is performed in the setting of trauma, while elective splenectomy is a planned procedure. Elective splenectomy is often performed laparoscopically and may involve extracting the spleen inside a specimen bag.
What are the common complications of splenectomy?
Common complications of splenectomy include hemorrhage (from short gastrics or splenic hilar vessels), pancreatic fistula (from iatrogenic damage to the pancreatic tail), thrombocytosis (requiring prophylactic aspirin), and encapsulated bacteria infection such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis.
What is primary intracerebral hemorrhage (PICH)?
Primary intracerebral hemorrhage (PICH) is a type of stroke that accounts for approximately 10% of cases. It is characterized by symptoms such as headache, vomiting, and loss of consciousness.
What are the characteristics of total anterior circulation infarcts (TACI)?
Total anterior circulation infarcts (TACI) involve the middle and anterior cerebral arteries. They are associated with symptoms such as hemiparesis/hemisensory loss, homonymous hemianopia, and higher cognitive dysfunction, such as dysphasia.
What are the characteristics of partial anterior circulation infarcts (PACI)?
Partial anterior circulation infarcts (PACI) involve the smaller arteries of the anterior circulation, such as the upper or lower division of the middle cerebral artery. They are associated with higher cognitive dysfunction or at least two of the three TACI features.
What are lacunar infarcts (LACI)?
Lacunar infarcts (LACI) involve the perforating arteries around the internal capsule, thalamus, and basal ganglia. They present with symptoms such as isolated hemiparesis, hemisensory loss, or hemiparesis with limb ataxia.
What are posterior circulation infarcts (POCI)?
Posterior circulation infarcts (POCI) involve the vertebrobasilar arteries. They present with features of brainstem damage, including ataxia, disorders of gaze and vision, and cranial nerve lesions.
What is lateral medullary syndrome (posterior inferior cerebellar artery)?
Lateral medullary syndrome, also known as Wallenberg’s syndrome, is caused by an infarct in the posterior inferior cerebellar artery. It is characterized by ipsilateral symptoms such as ataxia, nystagmus, dysphagia, facial numbness, and cranial nerve palsy. Additionally, it may cause contralateral limb sensory loss.
What is Weber’s syndrome?
Weber’s syndrome is characterized by ipsilateral third (III) cranial nerve palsy and contralateral weakness.
