Cerebrovascular Accident Flashcards
Location of CST at the brainstem
Ventral and Medial
Location of CST at the Internal Capsule
Posterior Limb
Two parts of the cerebral peduncle
Tegmentum and Crus Cerebri
Location of CST in Midbrain
Middle 3rd - ventral part (crus cerebri)
Location of decussation of CST in the Medulla
Pyramid
Two decussations of CST
Lateral CST (90%) and Anterior CST (10%)
Lateral CST supplies what area?
Appendicular Muscles
Anterior CST supplies what area?
Axial Muscles
What is the boundary of an upper and lower motor neuron?
Anterior Horn Cell
UMNL or LMNL: Hypertonia
UMNL
UMNL or LMNL: Bulbar Palsy
LMNL
Atrophy of LMNL
Denervated Atrophy (Severe Muscle Wasting)
UMNL or LMNL: Increase DTR
UMNL
Gold Standard of UMNL
Babinski sign
UMNL or LMNL: Flaccidity
LMNL
Atrophy of UMNL
Disused Atrophy (Anti-gravity muscle)
UMNL or LMNL: Spasticity
UMNL
UMNL or LMNL: Pseudobulbar Palsy and Effect
UMNL
UMNL or LMNL: Spontaneous muscle activity
LMNL
What innervates the Bulbar tract?
Spinal Nerve
What innervates the Pseudobulbar tract?
Cranial Nerve
Sudden onset of neurologic dysfunction secondary to loss of blood supply
Cerebrovascular Accident
Duration of CVA
> 24 hours
Duration of TIA
<24 hours
“Mini-stroke”
Transient Ischemic Attack
Age of stroke in the young
<45 years old
“Stroke in Evolution”
Deteriorating Stroke
The common cause of Stroke in the Young
Hemorrhagic
The common cause of Reversible Ischemic Neurologic deficit
Brain swelling / Swelling
The common cause of Deteriorating Stroke
Thrombus
Duration of Reversible Ischemic Neurologic deficit
> 24 hours to weeks
Braddom: TIA
(-) evidence of infarction upon the brain imaging
Anterior Blood Circulation
LCC & RCC –> ICA and ECA –> OCA, MCA, ACA, AComm
Watershed of MCA
Lenticulostriate
The largest terminal branch of ICA
MCA
Only stroke syndrome that can be asymptomatic
ACA
Watershed of ACA
Heubner
Innervation of Lenticulostriate
Posterior limb of the internal capsule and basal ganglia
Innervation of Heubner
Anterior limb of the internal capsule and globus pallidus
Areas where there is the least blood supply
Watershead
Posterior Blood Circulation
L & R subclavian –> Axillary & Vertebral –> Basilar –> PCA
The location of the vertebral artery combines to become a basilar artery
C6
The location where vertebrobasilar artery splits to become PCA
Midbrain
Branch of the vertebrobasilar artery in the medulla
PICA
Branches of the vertebrobasilar artery in the pons
AICA and Superior CA
PICA supplies what area of the brain?
Cerebellum and Lateral Medulla
Superior CA supplies what area of the brain?
Cerebellum and Lateral-Superior Pons
AICA supplies what area of the brain?
Cerebellum and Lateral-Inferior Pons
True or False: If affectation is AICA, PICA, or SUCA, there is an affectation of CST
False
In general, the brainstem is supplied by what artery?
Vertebrobasilar Artery
Weber is supplied by what artery?
Vertebrobasilar Artery and PCA
Components of Circle of Willis
ICA, ACA, AComm, PComm, PCA, Vertebrobasilar Artery
5 non-modifiable risk factors of CVA
Age, Gender, Race, Family History, Previous Stroke
7 modifiable risk factors of CVA
Heart Disease, Hypertension, Smoking, DM, Obesity, Hyperlipidemia, Previous Stroke
Gender predominantly affected in CVA
M>F
Gender predominantly affected in CVA in age >85 years old
Female
A race predominantly affected in CVA
African-American
Hyperlipidemia: Bad LDL
<100mg/dL
Hyperlipidemia: Total Cholesterol
<200mg/dL
Hyperlipidemia: Good HDL
> 60mg/dL
Percentage of the prevalence of hemorrhagic
20%
Percentage of the prevalence of ischemic
80%
Two etiology under hemorrhagic stroke
Intracerebral and Subarachnoid Hemorrhage
The most common cause of ICH
Hypertension
“Pseudoaneurysm”
Charcot Bouchard Aneurysm
Abnormal dilation of blood vessel
Aneurysm
Charcot Bouchard Aneurysm is common at what location in the brain?
Basal Ganglia
Aneurysm caused by?
Idiopathic
Charcot Bouchard Aneurysm caused by?
Long term hypertension
Five ICH sites
Putamen, Subcortical White Matter, Thalamus, Pons, Cerebellum
The most common site of ICH
Putamen
The least common site of ICH
Cerebellum
The most common cause of young stroke
Subarachnoid Hemorrhage
Two cause of Subarachnoid Hemorrhage
Saccular Aneurysm and Arteriovenous Malformation
Saccular Aneurysm and Arteriovenous Malformation ruptured when?
4th-5th decade of life
Saccular Aneurysm and Arteriovenous Malformation occur when?
Congenital
“Berry Aneurysm”
Saccular Aneurysm
(+) Tangled web of arteries
Arteriovenous Malformation
The chief complaint of patients with Saccular Aneurysm Subarachnoid Hemorrhage
Worst headache in my life
The diameter of Berry Aneurysm that will lead to rupture
> 10mm
Saccular Aneurysm sites of hemorrhage
Anterior Circulation: AComm, MCA, and ICA
Saccular Aneurysm MC site of hemorrhage
AComm
Triad of AVM
Hemorrhage, Seizures, Migrane
Three etiology of Ischemic Stroke
Thrombotic, Embolic, Lacunar
Percentage of the prevalence of Thrombotic Ischemic Stroke
40%
Percentage of the prevalence of Etiologic Ischemic Stroke
20-25%
“Small Vessel Thrombosis”
Lacunar Stroke
Sources of embolic ischemic stroke
Heart Embolism, Paradoxical Embolism
Percentage of the prevalence of Lacunar Ischemic Stroke
15-20%
Sites of Thrombotic Ischemic Stroke
MCA, CC, VBA
“Large Vessel Thrombosis”
Thrombotic Stroke
Lacunar Stroke: X Anterior Limb of Internal Capsule
Dysarthria, Clumsy Hand
Lacunar Stroke: X Junction of Internal Capsule and Thalamus
Sensorimotor
Most common lacunar stroke
Pure Motor
Lacunar Stroke: X Cerebellum & Internal Capsule
Ataxic Hemiparesis
Lacunar Stroke: X Posterior Limb of Internal Capsule
Pure Motor
2nd most common lacunar stroke
Sensorimotor
Lacunar Stroke: X Thalamus
Pure Sensory
Least common lacunar stroke
Dysarthria, Clumsy Hand
Lacunar Stroke: X Lenticulostriate
Pure Motor, Chorea, Dystonia
Lacunar Stroke: X Heubner
Dysarthria Clumsy Hand, Athetosis
Lacunar Stroke: X PCA
Pure Sensory, Hemiballismus
Lacunar Stroke: X Vertebrobasilar
Ataxic Hemiparesis
Hunt and Hess: Awake
I and II
Hunt and Hess: Coma
V
Hunt and Hess: Moderate-severe hemiparesis
IV
Hunt and Hess: Mild HA, Slight Nuchal Rigidity
I
Hunt and Hess: Confused / Drowsy
III
Hunt and Hess: Posturing and Herniation
V
Hunt and Hess: Stupor
IV
Hunt and Hess: HA, Nuchal Rigidity, CN involvement
II
Hunt and Hess: Mild focal neurological deficit
III
Innervation of ACA in lobes
Medial frontal and parietal
Innervation of PCA in lobes
Medial & Inferior temporal and occipital
Innervation of MCA in lobes
Lateral frontal, parietal, and temporal
Clinical Syndrome: Disconnection Apraxia
ACA
Clinical Syndrome: Memory Loss
PCA and MCA
Clinical Syndrome: Thalamic Pain Syndrome
PCA
Clinical Syndrome: Dysphagia
MCA
Clinical Syndrome: Amaurosis Fugax
ICA
Clinical Syndrome: Hemianopsia
MCA and PCA
“Alien Hand Syndrome”
Paratonia
Paratonia: Resist
Gegenhalten
Paratonia: Assist
Mitgehen
Peripheral PCA Syndrome affectation
Temporal and Occipital
Central PCA Syndrome affectation
SHET and Midbrain
PCA Temporal lobe affectation
Memory Loss
PCA Diencephalon affectation
C/L Hemiballismus and Thalamic Pain Syndrome
PCA Midbrain affectation
Weber and C/L Hemiplegia
PCA Occipital lobe affectation
Visual Problem
Clinical Syndrome: Paratonia
ACA
Clinical Syndrome: Balint Syndrome
PCA - peripheral
Clinical Syndrome: Apraxia
MCA and ACA
Clinical Syndrome: Urinary Bladder problem
ACA
MCA Syndrome: Representation
Right
MCA Syndrome: Quick and Impulsive
Right
MCA Syndrome: Gerstmann’s Syndrome
Left
MCA Syndrome: Denial
Right
MCA Syndrome: Sad and Depressed
Left
Left lobe apraxia
Ideomotor and Ideational Apraxia
MCA Syndrome: Rigidity of Thought
Right
Right lobe apraxia
Dressing and Constructional Apraxia
MCA Syndrome: Language related memory loss
Left
MCA Syndrome: Visuospatial related memory loss
Right
MCA Syndrome: Affective Agnosia
Right
memory loss
Left
Main branch Aphasia
Global Aphasia
4 clinical manifestation of Right Lobe
Neglect, Denial, Dressing and Constructional Apraxia
MCA Syndrome: Unware
Right
Upper branch Aphasia
Broca’s
Lower branch Aphasia
Wernicke’s
Gerstmann’s Syndrome
L & R discrimination, FInger agnosia, Agraphia, Acalculia (BA 312), and BA 39 (Angular Gyrus)
MCA Syndrome: Body scheme deficit
Right
MCA Syndrome: Difficulty in expressing positive emotion
Left
MCA Syndrome: Difficulty in expressing negative emotion
Right
MCA Syndrome: Crossed Aphasia
Right
Brainstem Syndrome: X CST
Weber, Locked-in, Millard-Gubler, Dejerine
Brainstem Syndrome: X Corticobulbar Tract
Locked-In
Location of Millard-Gubler
Lateral Pons
Location of Benedikt
Tegmentum of Midbrain
Brainstem Syndrome: X STT
Benedikt, Wallenburg
Brainstem Syndrome: Medial Basal of Midbrain
Weber
Location of Wallenburg
Lateral Medulla
Location of Locked-in
Bilateral Basal Pons
Brainstem Syndrome: Dejerine
Medial Medulla
Cranial Nerve Involvement of Dejerine
CN 12
Cranial Nerve Involvement of Weber
CN 3
Cranial Nerve Involvement of Millard-Gubler
CN 6-7
Cranial Nerve Involvement of Locked-In
CN 5-12
Cranial Nerve Involvement of Wallenburg
CN 5, 8, 9-11
Cranial Nerve Involvement of Benedikt
CN 3
Benedikt S/sx: X Medial Lemniscus
C/L Loss of position sense
Wallenburg S/sx: CN 5
I/L Hemi-sensory face
Benedikt S/sx: Superior Cerebellar Peduncle
C/L Ataxia
Benedikt S/sx: Red Nucleus
C/L Chorea
Wallenburg S/sx: Sympathetic Tract
I/L Horner Syndrome
Wallenburg S/sx: Inferior Cerebellar Peduncle
I/L ataxia
(+) Crossed Hemianesthesia
Wallenburg Syndrome
Blood supply of Weber
PCA and VBA
Blood supply of Dejerine
Anterior Spinal Artery
Blood supply of Wallenburg
PICA
Triad of Horner Syndrome
(1) Miosis (constricted pupil), (2) Partial ptosis, and (3) Anhidrosis (loss of hemifacial sweating)
* Exophthalmos: the sinking of the eyeball into the bony cavity that protects the eye
Aphasia: Good Writing
Anomia
Aphasia: Poor Fluency
Transmotor, Broca’s, Isolation of Language, Global
Aphasia: Good Repetition
Anomia, Transmotor, Transsensory, Isolation of Language
Aphasia: Poor Comprehension
Transsensory, Wernkicke’s, Isolation of Language, Global
Aphasia: Good Fluency and Repetition
Transcortical Sensory
Aphasia: Good Comprehension and Repetition
Transcortical Motor and Anomia
Aphasia: Angular Gyrus
Anomia
Aphasia: Surpamarginal Gyrus
Conduction
Aphasia: Medial Frontal Border Zone
Transcortical Motor
Aphasia: Wernicke + Broca
Global
Aphasia: Medial Parietal Border Zone
Transcortical Sensory
Pure word Aphasia: X Hesch’s Gyrus
Pure word Deafness
Pure word Aphasia: Aphemia
Pure word Mutism
Pure word Aphasia: Alexia without agraphia
Pure word Blindness
Pure word Aphasia: Poor reading comprehension only
Pure word Blindness
Pure word Aphasia: Poor Comprehension and Repetition
Pure word Deafness
Pure word Aphasia: Poor Naming, Fluency, Repetition
Pure word Mutism
Brunnstrom: Pron & Sup elbow flexion
Level 4
Brunnstrom: Mastered movement of synergy pattern
Level 3
Brunnstrom: Pron & Sup elbow extension
Level 5
Brunnstrom: Minimal voluntary movements
Level 2
Brunnstrom: Put hand behind
Level 4
Brunnstrom: Horizontal Abduction
Level 5
Functional Categories: (+) do household chores independently
Unlimited Household Walker
Functional Categories: (+) go to uncrowded places
Least Limited Community Walker
Functional Categories: Walks within parallel bars during exercise
Physiologic Walker
Functional Categories: (+) do household chores with assistance
Limited Household Walker
Functional Categories: (+) up and down curbs
Most Limited Community Walker
Functional Categories: (+) go uncrowded places
Least Limited Community Walker
Functional Categories: (+) up and down stairs
Least Limited Community Walker
