Ch 1 - Stroke: Types Flashcards by Chris Garrison

Where do most Internal carotid artery infarctions occur?

1st part of ICA immediately after carotid bifurcation

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What causes occular infarction?

Embolic occlusion of retinal branch or central retinal artery

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What is amaurosis fugax?

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

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Where do middle cerebral infarctions occur?

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

of the artery in the Sylvian sulcus

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What does the superior division of the MCA provide?

Rolandic and pre-Rolandic areas

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

Embolus

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What is the clinical presentation of superior division MCA strokes?

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

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

Global aphasia initially and then Broca’s aphasia

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

Spatial perception
Hemineglect
Constructional apraxia
Dressing apraxia

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What is constructional apraxia?

Inability of patients to copy accurately drawings or 3D constructions

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What does the Inferior division of the MCA supply?

Lateral temporal and inferior parietal lobes

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

Superior quadrantanopia or homonymous hemianopsia

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

Wernicke’s aphasia

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

Left visual neglect.

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

Well tolerated as there is blood supply from the contralateral ACA

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What is the clinical presentation of an ACA stroke?

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

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What are potential symptoms of an ACA stroke?

Urinary incontinence
Contralateral grasp reflex
Paratonic rigidity (Gegenhalten)

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What aphasia is seen with Left ACA stroke?

Transcortical aphasia

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

Aphasia
Paraplegia
Incontinence
Frontal lobe dysfunction

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What does the PCA supply?

Upper brain stem
Inferior temporal lobe
Medial occipital lobe

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What is seen with bilateral PCA stroke?

Anton’s syndrome: denial of cortical blindness

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What is the clinical presentation of PCA stroke?

Prosopagnosia
Palinopsia
Alexia
Transcortical sensory aphasia
CN3 and CN4 palsy

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What is prosopagnosia?

Can’t read faces

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What is Alexia?

Can’t read

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What is Weber syndrome?

Oculomotor palsy with contralateral hemiplegia

What is trochlear nerve palsy?

Vertical gaze palsy

What do the vertebrobasilar arteries supply?

``` Midbrain Pons Medulla Cerebellum Posterior and ventral aspects of the cerebral hemispheres ```

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

Form basilar artery at pontomedullary junction

What creates the posterior-inferior cerebellar (PICA)?

Vertebral arteries

What creates the anterior-inferior cerebellar (AICA)?

Superior cerebellar arteries that arise from the Basilar artery

What are symptoms of vertebrobasilar system strokes?

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

What are crossed signs?

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

What is a characteristic of vertebrobasilar anterior circulation involvement?

Absence of cortical signs (aphasia or cognitive deficits)

Describe vertigo in vertebrobasilar insufficiency.

Usually last <30 minutes and have no hearing loss

What arteries can be involved with Wallenberg syndrome?

PICA Vertebral arteries Superior, middle or inferior lateral medullary artery

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

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

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

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

What is not seen in Wallenberg syndrome?

Facial or extremity weakness

What structures are effected in Benedikt syndrome?

Red nucleus | Tegmentum of midbrain

What are the symptoms of medial lemniscus damage?

Ipsilateral CN3 paralysis with mydriasis | Contralateral hypesthesia

What are the symptoms of red nucleus damage?

Contralateral hyperkinesia (ataxia, tremor, chorea, athetosis)

What is the clinical presentation of Weber syndrome?

Ipsilateral CN3 palsy | Contralateral hemiplegia, Parkinson's signs and dystaxia

What is the clinical presentation of Millard-Gubler syndrome?

Ipsilateral CN6 and 7 palsy | Contralateral hemiplegia, analgesia, hypoesthesia

What is the clinical presentation of Medial Medullary syndrome?

Ipsilateral CN12 palsy | Contralateral hemiplegia and proprioception loss

What is affected in Weber syndrome?

PCA | Base on midbrain

What is affected in Millard-Gubler syndrome?

Basilar artery | Base of pons

What is affected in Medial Medullary/Wallenberg syndrome?

Vertebral or anterior | spinal artery

What causes Locked-in syndrome?

Bilateral lesions of the ventral pons (basilar artery occlusion)

What are the Lacunar syndromes?

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

What causes intracerebral hemorrhages (ICH)?

Chronic HTN and development of microaneurysms

What are common symptoms of intracerebral hemorrhages (ICH)?

Headache and/or LOC Vomiting Seizures Nuchal rigidity

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

Putamen

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

Stupor/coma | Hemiplegia

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

Headache Eyes deviate away from lesion Hemiplegia

What is seen with thalamus intracerebral hemorrhages (ICH)?

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

What is seen with Pons intracerebral hemorrhages (ICH)?

Deep coma Total paralysis Decerebrate rigidity

What is seen with Cerebellum intracerebral hemorrhages (ICH)?

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

What is seen with Cerebral intracerebral hemorrhages (ICH)?

HA Vomiting Deficits based on location

What causes Subarachnoid Hemorrhages?

Typically ruptured saccular (berry) aneurysm

Where do most saccular (berry) aneurysm occur?

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

When are aneurysms most likely to rupture?

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

What scale is used for nontraumatic SAH?

Hunt and Hess scale

What is a Hunt and Hess scale grade 1?

Asymptomatic Mild HA Slight nuchal rigidity

What is a Hunt and Hess scale grade 2?

Moderate to severe HA Nuchal rigidity Cranial nerve palsy

What is a Hunt and Hess scale grade 3?

Drowsiness/confusion | Mild focal neurologic deficit

What is a Hunt and Hess scale grade 4?

Stupor | Moderate-severe hemiparesis

What is a Hunt and Hess scale grade 5?

Coma | Decerebrate posturing

When can CN3 be compressed with saccular aneurysms?

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

What is the clinical presenation of CN3 palsy?

Lateral deviation of ipsilateral eye Ptosis Mydriasis Paralysis of accommodation

What are symptoms of saccular aneurysm rupture?

Sentinel HA

What is the prognosis of saccular aneurysm rupture?

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

What medications can be used for cerebral vasospasm?

Nimodipine (calcium channel blocker)

What are arteriovenous | malformations (AVM)?

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

How do arteriovenous | malformations (AVM) cause hemorrhage?

Low pressure systems so need occlusion distally to raise luminal pressure

What is the lifetime risk of arteriovenous | malformations (AVM) causing hemorrhage?

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

What is the clinical presentation of arteriovenous | malformations (AVM) rupture?

Hemorrhage Seizures HA Neurologic deficit based on location