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Cuccurullo Book > Ch 1 - Stroke: Types > Flashcards

Ch 1 - Stroke: Types Flashcards

1
Q

Where do most Internal carotid artery infarctions occur?

A

1st part of ICA immediately after carotid bifurcation

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2
Q

What causes occular infarction?

A

Embolic occlusion of retinal branch or central retinal artery

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3
Q

What is amaurosis fugax?

A

Transient monocular blindness that occurs prior to ICA occulsion in 25% of cases

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4
Q

Where do middle cerebral infarctions occur?

A

Stem of the MCA or at main divisions (superior or inferior)

of the artery in the Sylvian sulcus

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5
Q

What does the superior division of the MCA provide?

A

Rolandic and pre-Rolandic areas

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6
Q

What is the most common cause of occlusion of superior division of MCA?

A

Embolus

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7
Q

What is the clinical presentation of superior division MCA strokes?

A

Sensory and motor deficits on contralateral face and arm > leg
Eyes deviate toward lesion

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8
Q

What is the clinical presentation of left side (dominant) superior division MCA strokes?

A

Global aphasia initially and then Broca’s aphasia

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9
Q

What are deficits of right side (nondominant) superior division MCA strokes?

A

Spatial perception
Hemineglect
Constructional apraxia
Dressing apraxia

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10
Q

What is constructional apraxia?

A

Inability of patients to copy accurately drawings or 3D constructions

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11
Q

What does the Inferior division of the MCA supply?

A

Lateral temporal and inferior parietal lobes

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12
Q

What visual deficit is seen with Inferior division of the MCA stroke?

A

Superior quadrantanopia or homonymous hemianopsia

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13
Q

What is the clinical presentation of Left Inferior division of the MCA stroke?

A

Wernicke’s aphasia

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14
Q

What is the clinical presentation of Right Inferior division of the MCA stroke?

A

Left visual neglect.

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15
Q

What happens if there is an occlusion of the ACA proximal to the anterior communicating artery?

A

Well tolerated as there is blood supply from the contralateral ACA

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16
Q

What is the clinical presentation of an ACA stroke?

A

Contralateral weakness and sensory loss of foot/leg >thigh
Gait apraxia
Eyes deviate toward lesion

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17
Q

What are potential symptoms of an ACA stroke?

A

Urinary incontinence
Contralateral grasp reflex
Paratonic rigidity (Gegenhalten)

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18
Q

What aphasia is seen with Left ACA stroke?

A

Transcortical aphasia

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19
Q

What is seen with ACA stroke if both ACA arteries arise from one major stem?

A

Aphasia
Paraplegia
Incontinence
Frontal lobe dysfunction

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20
Q

What does the PCA supply?

A

Upper brain stem
Inferior temporal lobe
Medial occipital lobe

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21
Q

What is seen with bilateral PCA stroke?

A

Anton’s syndrome: denial of cortical blindness

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22
Q

What is the clinical presentation of PCA stroke?

A 
Prosopagnosia
Palinopsia
Alexia
Transcortical sensory aphasia
CN3 and CN4 palsy
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23
Q

What is prosopagnosia?

A

Can’t read faces

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24
Q

What is Alexia?

A

Can’t read

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25
Q

What is Weber syndrome?

A

Oculomotor palsy with contralateral hemiplegia

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26
Q

What is trochlear nerve palsy?

A

Vertical gaze palsy

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27
Q

What do the vertebrobasilar arteries supply?

A 
Midbrain
Pons
Medulla
Cerebellum
Posterior and
ventral aspects of the cerebral hemispheres
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28
Q

Where do the vertebral arteries join and what do they form?

A

Form basilar artery at pontomedullary junction

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29
Q

What creates the posterior-inferior cerebellar (PICA)?

A

Vertebral arteries

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30
Q

What creates the anterior-inferior cerebellar (AICA)?

A

Superior cerebellar arteries that arise from the Basilar artery

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31
Q

What are symptoms of vertebrobasilar system strokes?

A 
– Vertigo
– Nystagmus
– ABN of motor function, often bilaterally
– Ipsilateral cranial nerve dysfunction
– Crossed signs
32
Q

What are crossed signs?

A

Motor or sensory deficit on ipsilateral side of face and contralateral side of body; ataxia, dysphagia, dysarthria

33
Q

What is a characteristic of vertebrobasilar anterior circulation involvement?

A

Absence of cortical signs (aphasia or cognitive deficits)

34
Q

Describe vertigo in vertebrobasilar insufficiency.

A

Usually last <30 minutes and have no hearing loss

35
Q

What arteries can be involved with Wallenberg syndrome?

A

PICA
Vertebral arteries
Superior, middle or inferior lateral medullary artery

36
Q

What is the clinical presentation of Wallenberg syndrome on the Ipsilateral side?

A

Horner’s syndrome
Dec pain and temp sensation of face
Ataxia/falls to lesion

37
Q

What is the clinical presentation of Wallenberg syndrome on the Contralateral side?

A 
Dec pain and temp on body
Dysphagia
Dysarthria
Hoarseness/vocal cord paralysis
Vertigo
Hiccups
Nystagmus, diplopia
38
Q

What is not seen in Wallenberg syndrome?

A

Facial or extremity weakness

39
Q

What structures are affected in Benedikt syndrome?

A

Red nucleus

Tegmentum of midbrain

40
Q

What are the symptoms of medial lemniscus damage?

A

Ipsilateral CN3 paralysis with mydriasis

Contralateral hypesthesia

41
Q

What are the symptoms of red nucleus damage?

A

Contralateral hyperkinesia (ataxia, tremor, chorea, athetosis)

42
Q

What is the clinical presentation of Weber syndrome?

A

Ipsilateral CN3 palsy

Contralateral hemiplegia, Parkinson’s signs and dystaxia

43
Q

What is the clinical presentation of Millard-Gubler syndrome?

A

Ipsilateral CN6 and 7 palsy

Contralateral hemiplegia, analgesia, hypoesthesia

44
Q

What is the clinical presentation of Medial Medullary syndrome?

A

Ipsilateral CN12 palsy

Contralateral hemiplegia and proprioception loss

45
Q

What is affected in Weber syndrome?

A

PCA

Base of midbrain

46
Q

What is affected in Millard-Gubler syndrome?

A

Basilar artery

Base of pons

47
Q

What is affected in Medial Medullary/Wallenberg syndrome?

A

Vertebral or anterior

spinal artery

48
Q

What causes Locked-in syndrome?

A

Bilateral lesions of the ventral pons (basilar artery occlusion)

49
Q

What are the Lacunar syndromes?

A 
Pure motor hemiplegia
Pure sensory stroke
Dysarthria/clumsy hand syndrome
Sensorimotor stroke
Ataxia and leg paralysis
Hemichorea-hemiballismus
50
Q

What causes intracerebral hemorrhages (ICH)?

A

Chronic HTN and development of microaneurysms

51
Q

What are common symptoms of intracerebral hemorrhages (ICH)?

A

Headache and/or LOC
Vomiting
Seizures
Nuchal rigidity

52
Q

What is the most common location of an intracerebral hemorrhages (ICH)?

A

Putamen

53
Q

What is seen with large putamen intracerebral hemorrhages (ICH)?

A

Stupor/coma

Hemiplegia

54
Q

What is seen with small putamen intracerebral hemorrhages (ICH)?

A

Headache
Eyes deviate away from lesion
Hemiplegia

55
Q

What is seen with thalamus intracerebral hemorrhages (ICH)?

A

Hemiplegia
Contralateral sensory deficits
Aphasia w/ dominant
Contralateral hemineglect w/ nondominant

56
Q

What is seen with Pons intracerebral hemorrhages (ICH)?

A

Deep coma
Total paralysis
Decerebrate rigidity

57
Q

What is seen with Cerebellum intracerebral hemorrhages (ICH)?

A 
Coma/LOC
Vomiting
Occipital HA
Vertigo
Ipsilateral CN6 palsy
Dsyarthria
Dysphagia
Cant sit, stand or walk
58
Q

What is seen with Cerebral intracerebral hemorrhages (ICH)?

A

HA
Vomiting
Deficits based on location

59
Q

What causes Subarachnoid Hemorrhages?

A

Typically ruptured saccular (berry) aneurysm

60
Q

Where do most saccular (berry) aneurysm occur?

A

90% to 95% at anterior part of the Circle of Willis

61
Q

When are aneurysms most likely to rupture?

A

Size >10 mm
During activity
5th and 6th decade

62
Q

What scale is used for nontraumatic SAH?

A

Hunt and Hess scale

63
Q

What is a Hunt and Hess scale grade 1?

A

Asymptomatic
Mild HA
Slight nuchal rigidity

64
Q

What is a Hunt and Hess scale grade 2?

A

Moderate to severe HA
Nuchal rigidity
Cranial nerve palsy

65
Q

What is a Hunt and Hess scale grade 3?

A

Drowsiness/confusion

Mild focal neurologic deficit

66
Q

What is a Hunt and Hess scale grade 4?

A

Stupor

Moderate-severe hemiparesis

67
Q

What is a Hunt and Hess scale grade 5?

A

Coma

Decerebrate posturing

68
Q

When can CN3 be compressed with saccular aneurysms?

A

Posterior communicating-internal carotid junction aneurysm or posterior communicating-posterior cerebral
artery aneurysm

69
Q

What is the clinical presenation of CN3 palsy?

A

Lateral deviation of ipsilateral eye
Ptosis
Mydriasis
Paralysis of accommodation

70
Q

What are symptoms of saccular aneurysm rupture?

A

Sentinel HA

71
Q

What is the prognosis of saccular aneurysm rupture?

A

25% mortality in 1st 24hr
30% rebleed in 1st mo
60% mortality from rebleed

72
Q

What medications can be used for cerebral vasospasm?

A

Nimodipine (calcium channel blocker)

73
Q

What are arteriovenous

malformations (AVM)?

A

Tangled mass of dilated vessels that forms communication b/w the arterial and venous systems

74
Q

How do arteriovenous

malformations (AVM) cause hemorrhage?

A

Low pressure systems so need occlusion distally to raise luminal pressure

75
Q

What is the lifetime risk of arteriovenous

malformations (AVM) causing hemorrhage?

A

40-50% risk
MC in smaller AVMs
MC in 20-40 yo

76
Q

What is the clinical presentation of arteriovenous

malformations (AVM) rupture?

A

Hemorrhage
Seizures
HA
Neurologic deficit based on location

Cuccurullo Book (91 decks)

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