Chapter 14: Vascular Disease Flashcards
Anterior (carotid) circulation supplies….
Cerebral hemispheres except for the medial temporal lobes and a portion of the occipital lobes.
Posterior (vertebro-basilar) circulation supplies…
The brainstem, thalami, cerebellum, and the posterior portions of the cerebral hemisphere
Know the anterior and posterior circulations
!!!
Percent of ischemic vs. hemorrhagic strokes
80% ischemic, 10% subarachnoid and intracerebral hemorrhages each
Different types of ischemic strokes
Thrombotic, embolic, and systemic hypoperfusion mechanisms
Thrombotic strokes
Large vessels for atherosclerotic
Smaller, penetrating intracranial arteries caused by HTN
Embolisms come mostly from…
The heart. Also from the aorta, ICAs, and VAs, and from systemic veins
Systemic Hypoperfusion from…
MI or arrhythmia and systemic hypotension from hypovolemia. Think about watershed strokes for this one.
Left Cerebral Hemisphere Strokes signs…
Motor: Right hemiparesis (arm,hand,face>leg)
Sensory: Right hemisensory loss
Cognitive: Aphasia
Deep or large lesions: conjugate deviation of the eyes to the left; right hemianopia or hemi-inattention
ICA occlusive disease leads to…
Transient monocular visual loss along with the other signs of cerebral hemisphere strokes
Right Cerebral Hemisphere Strokes signs…
Motor: Left hemiparesis (arm,hand,face>leg)
Sensory: Left hemisensory loss
Cognitive: Poor drawing, copying, neglect of left visual field
Deep or large lesions: conjugate deviation of the eyes to the right; left hemianopia
Lateral medulla stroke signs
Sensory: Ipsilateral facial pain, or reduced pain and temperature sensation on the ipsilateral face, or both;
Loss of pain and temperature in the contralateral limbs and body; Ipsilateral Horner syndrome
Motor: Nystagmus; incoordination of the ipsilateral arm; leaning and veering while sitting or walking with gait ataxia
Deep lesions: Dysphagia and hoarseness
Cause: intracranial VA occlusion
Bilateral pontine base and often medial tegmentum stroke signs
Motor: Quadriparesis; unilateral or bilateral conjugate gaze paresis; sometimes internuclear ophthalmoplegia or VIth nerve palsy
Cognitive: Coma if medial tegmentum involved bilaterally
Cause: Basilar artery occlusion, pontine hemorrhage
Cerebellar infarction signs
Motor: Gait ataxia (can’t walk); dysarthria; ipsilateral arm dysmetria
Cause: embolism of PICA or SCA or cerebellar hemorrhage
Left PCA territory strokes signs
Right hemianopia; right hemisensory symptoms; dysmemory; alexia without agraphia
Right PCA territory stroke signs
Left hemianopia; left hemisensory symptoms and left visual neglect
PCA territory infarcts are caused mostly by…
Embolism to the PCAs arising from the heart, aorta, or VAs
Lacunar strokes occur in anterior or posterior circulations…
BOTH
Lacunar Pure motor stroke signs
Weakness of arm, face, and leg on one side of the body without sensory, visual, or cognitive or behavioral signs.
Lacunar Pure sensory stroke signs
Paresthesiae on one side of the body and limbs and face, without motor, visual, or cognitive abnormalities.
Lacunar Dysarthria-clumsy hand syndrome signs
Slurred speech and clumsiness of one hand
Lacunar Ataxic hemiparesis signs
Weakness and Ataxia of the limbs on one side of the body
Treatment for cardiac embolism stroke, arterial dissection and acute large artery occlusions
Heparin and later warfarin
Lacunar infarction and nonocclusive atherosclerotic lesions treatment
Antiplatelet drugs-aspirin, clopidogrel, a combo of aspirin and modified-release dipyridamole, or cilostazole
