Cerebrovascular Stroke Flashcards
Explain what hyaline arteriosclerosis is
Hyaline arteriolosclerosis due to chronic hypertension can cause progressive narrowing of arterioles, thus manifesting as an ischaemic stroke. This can then create small lacunar, or “lake-like” cavities within the brain.
Explain what Charcot-Bourchard microaneurysms are
Prolonged hypertension can lead to the formation of Charcot-Bouchard microaneurysms, which are small fusiform aneurysms. May occur on top of hyaline arteriosclerosis. Rupture leads to haemorrhagic stroke.
Which major cerebral vessel are the lenticulostriate vessels branches of?
Middle cerebral artery
Risk factors for stroke?
- Older age
- Smoking
- PMHx/FHx of stroke
- AF
- Hypertension
- Diabetes
- Dyslipidaemia
- Comorbid heart conditions e.g. valvular disease, etc.
- Carotid artery stenosis
- Sickle cell disease
- Low SES/education
Briefly describe macroscopic findings on autopsy 2-3 days post-ischaemic stroke
- Softening
- Blurring of cortico-medullary junction (grey-white junction)
MCA stroke symptoms?
Affects motor+sensory cortices + potentially Broca+Wernicke’s areas:
- Contralateral paralysis + sensory loss of face + upper limb
- Aphasia if in dominant hemisphere (usually left)
- Hemineglect if in non-dominant hemisphere
ACA stroke symptoms?
Affects motor+sensory cortices
- Contralateral paralysis + sensory loss of lower limb + pelvic floor
Lenticulostriate arteries stroke symptoms?
Affects striatum + internal capsule
- Contralateral paralysis face + body
- No sensory signs
- No cortical signs (e.g. neglect, aphasia)
Posterior cerebral artery stroke symptoms?
Contralateral homonymous hemianopia with macular sparing (macula: dual MCA+PCA supply)
Anterior inferior cerebellar artery stroke symptoms?
Lateral pontine syndrome
- Vertigo, vomiting, nystagmus, hemiataxia
- Hearing loss + tinnitus (cochlear nuclei)
- Ipsilateral facial paralysis + sensory loss (facial nuclei)
- Contralateral loss of pain + temperature sensation of limbs+trunk
Facial paralysis + hearing involvement differentiates this with lateral medullary syndrome
Posterior inferior cerebellar artery stroke symptoms?
Lateral medullary (Wallenberg) syndrome
- Ipsilateral loss of sensation of face + Horner’s syndrome
- Contralateral loss of sensation of limbs + trunk
- Vertigo, nystagmus, ataxia
- Dysarthria, dysphagia, dysphonia
Last dot point differentiates this with lateral pontine syndrome
Basilar artery stroke symptoms?
Locked-in syndrome
- Quadriplegia
- Vertical eye movements, blinking spared
Anterior spinal artery stroke symptoms?
At level of medulla: Central cord/medial medullary syndrome
- Tongue deviating to infarcted side
- Contralateral limb weakness/hemiplegia + loss of proprioception + vibration
- Pain and temperature sensation preserved
At level of spinal cord: Anterior cord syndrome
- Complete paralysis below lesion
- Autonomic dysfunction e.g. hypotension, incontinence
- Loss of pain+temperature sensation below lesion
- Proprioception + vibration preserved
What is Brown-Sequard Syndrome?
Damage to half of the spinal cord
- Ipsilateral paralysis + loss of proprioception+vibration
- Contralateral loss of pain + temperature
