CVA Clinical Syndromes Flashcards by John Gonzales

List various stroke types based on vascular supply

ACA infarct
MCA infarct
- superior branch
- inferior branch
- stem
PCA infarct
Basilar Artery infarct
Vertebral artery infarct
IC artery infarct
Superior cerebellar artery infarct
Posterior cerebellar artery infarct
Anterior inferior cerebellar artery infact

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List some clinical syndromes for strokes

Lacunar infarcts
Watershed infarcts
Medial Medullary Syndrome
Lateral Medullary Syndrome (Wallenberg’s)
Horner’s syndrome
Medial Inferior Pontine syndrome
Lateral Inferior Pontine synrome
Complete basilar artery syndrome/Locked-in Syndrome

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what regions of the brain does the ACA supply (generally)?

anterior and medial surface of the brain
from frontal lobe to anterior parietal lobe
Corpus callosum

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List S/S of ACA syndrome

Contralateral hemiparesis or hemiplegia (LE > UE)
Contralateral hemisensory loss (LE < UE)
Apraxia
Problems w/bimanual tasks
Sig cognitive deficits
- agitation, memory, emotional liability, motor performance
Lack of spontaneity, motor inaction, slowness and delay
Difficulty w/executive function tasks (attention, etc.)
Transcortical Aphasia
Contralateral grasp reflex, sucking reflex
Alien hand syndrome
Urinary incontience

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list some S/S that are more often associated with L ACA syndrome

R leg weakness and sensory deficits
grasp reflex
possible transcortical aphasia
may see apraxia (less common)

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list some S/S that are more often associated with R ACA syndrome

L leg weakness and sensory deficits
grasp reflex
may see L neglect (less common)

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what regions of the brain does the MCA supply (generally)?

superior branch of MCA
- lateral and inferior frontal lobe
- anterior and lateral parietal lobe
inferior branch of MCA
- lateral temporal lobe
- lateral occipital lobe

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List S/S of MCA syndrome

Contralateral paresis (UE and face > LE)
Contralateral sensory loss (UE and face > LE)
Motor speech impairment
receptive speech impairment
global aphasia
perceptual deficits
apraxia
visual deficits
loss of conjugate gaze to opposite side
pure motor hemiplegia (lacunar stroke)

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list S/S specific to L MCA syndrome (superior divison)

R face, arm weakness
may see R face, arm sensory deficits
non-fluent (Broca’s) aphasia
apraxia
may see R visual field loss or dysconjugate gaze

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list S/S specific to L MCA syndrome (inferior division)

fluent (Wernicke’s) aphasia
R visual field loss
R face and arm sensory deficits
some mild R face, arm weakness

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list S/S of L and R MCA syndrome (deep branch)

pure motor hemiparesis

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list S/S of L MCA syndrome (stem)

R face, arm weakness and sensory deficits
R visual field loss and dyconjugate gaze
global aphasia

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list S/S of R MCA syndrome (superior division)

L face, arm weakness
L hemineglect
May see L face, arm sensory deficits
may see L visual field loss or dysconjugate gaze

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list S/S of R MCA syndrome (inferior division)

L face, arm weakness
profound L hemineglect and other perceptual deficits
L face, arm sensory deficits
L visual field loss

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list S/S of R MCA syndrome (stem)

L face, arm weakness
L face, arm sensory deficits
L visual field loss, dysconjugate gaze
L hemineglect and other perceptual deficits

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what regions of the brain does the PCA supply (generally)?

occipital lobe
posteriomedial temporal lobes

List S/S of PCA syndrome

contralateral homonymous hemianopia
Cortical blindness
visual agnosia
prosopagnosia
dyslexia
memory deficit
topographic disorientation

list S/S of L PCA syndrome

right homonymous hemianopia
memory deficits
visual agnosia, prosopagnosia
Larger infarcts:
- dyslexia, alexia (impacting posterior corpus callosum)
- right hemisensory loss, right hemiparesis (impacting thalamus/internal capsule)

list S/S of R PCA syndrome

left homonymous hemianopia
topographic disorientation
larger infarcts:
- left hemisensory loss, left hemiparesis (impacting thalamus, internal capsule)

What is superior cerebellar artery syndrome?

occlusion to superior cerebellar artery

damage to descending sympathetic tracts

List S/S of superior cerebellar artery syndrome

Ipsilateral cerebellar syndrome + Horner’s syndrome

cerebellar s/s:
- cerebellar ataxia
- dizziness
- horizontal nystagmus
- paresis of conjugate gaze
Horner’s syndrome:
- ptosis
- miosis
- anihidrosis
- ipsilateral dorsal column loss, contralateral spinothalamic loss
- dysphagia, dysphonia

what is medial medullary syndrome?

occlusion to anterior spinal artery or medial medullary branches of the vertebral artery

what brain areas are impacted by medial medullary syndrome?

medial medulla oblongata
- lateral corticospinal tract
- medial lemnsicus
- hypoglossal nerve

list S/S of medial medullary syndrome

paralysis of UE and LE (contralateral)
impaired tactile and proprioceptive sense
decreased pain and temp sensation in face (ipsilateral)
paralysis w/atrophy of half tongue w/deviation to the paralyzed side when tongue protruded (ipsilateral)

what is Wallenburg's syndrome?

ie Lateral Medullary Syndrome occlusion of posterior inferior cerebellar artery or vertebral artery

what brain areas are impacted by Wallenburg's syndrome?

1. medulla oblongata 2. choroid plexus of 4th ventricle 3. dentate nucleus \*this is the main supplier of blood to cerebellum

list S/S of Wallenburg's syndrome

1. Vertigo 2. N/V 3. Nystagmus 4. Ataxia 5. Balance and gait coordination problems 6. Contralateral facial pain/temp loss 7. Contralateral body pain/temp loss

what is medial inferior pontine syndrome?

occlusion of paramedian branch of basilar artery

what brain areas are impacted by medial inferior pontine syndrome?

1. CN VI nucleus 2. medial lemniscus 3. pontine center 4. vestibular nuclei 5. middle cerebellar peduncle 6. CST and corticobulbar tracts

List S/S of medial inferior pontine syndrome

1. Ipsilateral to lesion * paralysis of conjugate gaze * nystagmus * ataxia of limbs and gait * diplopia on lateral gaze 2. Contralateral to lesion * paresis of face, UE and LE * impaired tactile and proprioception

what is lateral inferior pontine syndrome?

occlusion of anterior inferior cerebellar artery, branch of basilar artery

what brain areas are impacted by lateral inferior pontine syndrome?

1. CN V (sensory) nuclei 2. CN VII nuclei 3. CN VIII nuclei 4. pontine center 5. middle cerebral peduncle 6. cerebellar hemisphere

list S/S of lateral inferior pontine syndrome

1. Nystagmus 2. vertigo 3. N/V 4. ipsilateral facial paralysis and sensory loss 5. ipsilateral paralysis of conjugate gaze 6. hearing loss, tinnitus 7. ataxia 8. contralateral pain and temp loss of body (sometimes face)

what is locked-in syndrome?

occlusion of basilar artery leading to bilateral ventral pontine infarct

list S/S of locked-in syndrome

1. acute hemiparesis that progresses to fully body tetraplegia 2. lower bulbar paralysis (IV-XII involvement) * upward eye movements and blinking are usually the only motor spared 3. Mutism (loss of voice) 4. cognition is spared