CVA Clinical Syndromes Flashcards
What lobe is affected with ACA stroke? What does this cause?
- frontal lobe which causes cognitive deficits like: Agitation Memory impairments Executive Function impairments Attention deficits Emotional lability/lack of emotional regulation Motor perseveration Lack of spontaneity Delayed processing
What part of the body is impacted more with ACA stroke? What side will symptoms present on?
LE > UE b/c interior part of brain (homunculus)
pt will have contralateral hemiplegia and hemisensory loss
What are some common signs and symptoms of an ACA stroke?
- What side will they occur on?
- apraxia - difficulty w/ skilled movements (dominant/left > nondominant/right)
- transcortical aphasia - stuttering speech - damage to sup. motor area
- contralateral grasp and sucking reflexes
- urinary incontinence
- visual deficits
Medial medullary syndrome stroke artery involved
vertebral artery
Lateral medullary syndrome (Wallenberg’s Syndrome) artery involved
PICA
Medial Inferior Pontine Syndrome artery involved
Basilar artery
Lateral Inferior Pontine Syndrome artery involved
AICA
What is the only stroke that has hearing involvement?
lateral inferior pontine syndrome
lateral superior pontine syndrome artery involved
superior cerebellar artery
vertebrobasilar artery syndrome (locked-in syndrome) artery involved
basilar artery/posterior circulation
lacunar infarcts artery involved
lenticulostriate arteries off MCA
What part of the body is impacted more with MCA stroke? What side will symptoms present on?
- UE > LE
- contralateral hemiplegia and hemisensory loss
What are common S & S of MCA stroke?
- dysarthria (slurring of speech bc of facial deficits)
- apraxia and aphasia (dominant > nondominant)
- perceptual deficits (nondominant > dominant) - agnosias, neglect, spatial disorientation
- behavior impairments
- visual deficits
- contralateral dysconjugate gaze
- sensory ataxia
Which side of the brain is more commonly affected by MCA apraxia and aphasia?
dominant (left) > nondominant (right)
Which side of the brain is more commonly affected by perceptual deficits after MCA stroke?
What kind of deficits are they?
nondominant (right) > dominant (left)
- agnosias, neglect, spatial disorientation
If MCA stroke occurred on the left side of the brain, what kind of behavior would the patient have?
dominant side - cautious behavior
If MCA stroke occurred on the right side of the brain, what kind of behavior would the patient have?
nondominant side - impulsive behavior
What kind of impairments would you see with Superior MCA stroke?
- motor impairments (motor cortex)
- behavior impairments (frontal)
- perception impairments (parietal)
What kind of impairments would you see with Inferior MCA stroke?
- walkie talkie - walk normally w/ no motor impairments but talk gibberish due to Wernicke’s and speech impairments
- may have some facial impairments based on the homunculus
What are common S & S of lacunar infarcts? What occurs if internal capsule or basal ganglia are damaged?
motor impairments
- NO SENSORY, no behavior, no coordination if internal capsule damaged
- Significant motor control & motor planning deficits if basal ganglia damaged
What are common S & S of PCA stroke?
- vision
- visual agnosia (dominant > nondominant)
- Prosopagnosia (face blindness)
- dyslexia
- memory (temporal)
- Topographical disorientation (nondominant > dominant)
What side is affected more with PCA stroke when it comes to visual agnosia and Topographical disorientation?
- visual agnosia - dominant > nondominant
- Topographical disorientation - nondominant > dominant
What will you see with deep PCA stroke?
- thalamic pain
- Spontaneous pain & dysesthesias
- involuntary movements
- contralateral hemiplegia
- motor and sensory impairments
What is the cause of watershed infarcts?
severe/sudden drops in BP
What is the result of ACA-MCA watershed infarct?
- proximal limb involvement - “man in barrel syndrome”
- dominant hemisphere - transcortical aphasia
What is the result of MCA-PCA watershed infarct?
disturbances in higher-order visual processing
What are common S & S of right-sided hemispheric strokes?
- easily agitated, poor insight, impulsive
- need bed alarms
- visual issues
- memory, abstract thought, problem solving
What are common S & S of left-sided hemispheric strokes?
- more cautious and nervous
- more guarded and move slowly
- speech and language impairments
- Disorganized problem solving/difficulty planning sequence
- Ideational and ideamotor
medial medullary syndrome S & S
vertebral artery
- ipsilateral tongue weakness
- contralateral UE/LE weakness
- contralateral UE/LE sensory loss (dorsal column)
lateral medullary (Wallenburg’s) syndrome S & S
PICA
- Ipsilateral facial pain/temp loss
- contra UE/LE sensory loss (dorsal and anterolateral system)
- ipsi ataxia
- vertigo, N/V
- nystagmus
- dysphagia, dysphonia, impaired gag reflex
- ipsi Horner’s (miosis, ptosis, anydrosis)
medial inferior pontine syndrome S & S
Basilar artery
Ipsilateral
- paralysis of conjugate gaze to side of lesion
- nystagmus
- ataxia of limbs and gait
- diplopia on lateral gaze (double vision)
- ipsi abducens damage
Contralateral
- facial and UE/LE weakness
- contra sensory facial and UE/LE sensory loss - dorsal column
lateral inferior pontine syndrome S & S
AICA
Ipsilateral - nystagmus - vertigo, N/V - facial weakness - Paralysis of conjugate gaze to side of lesion - deafness, tinnitus - ataxia - ipsi facial sensory loss (CN 5) Contralateral - facial and UE/LE sensory loss - anterolateral system
lateral superior pontine syndrome S & S
superior cerebellar artery
Ipsilateral - cerebellar ataxia of limbs and gait, falling to side of lesion - lateropulsion - ipsi ataxia - lateropulsion - dizziness, nausea, vomiting - nystagmus - paresis of conjugate gaze - Horner's syndrome Contralateral - facial pain/temp loss - contra LE>UE sensory loss - dorsal column
vertebrobasilar artery syndrome (locked-in syndrome) S & S
- tetraplegia
- bilateral cranial nerve palsy, upward gaze and blink is spared
- coma
- cognition is spared
Which sided stroke will have problems expressing negative emotions? positive emotions?
negative = right
positive = left
miosis
excessive constriction of the pupil of the eye
ptosis
upper eyelid droops over the eye
anhydrosis
inability to sweat normally
