CVA Clinical Syndromes Flashcards
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
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
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
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
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)
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)
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
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)
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
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
list S/S of L and R MCA syndrome (deep branch)
pure motor hemiparesis
list S/S of L MCA syndrome (stem)
- R face, arm weakness and sensory deficits
- R visual field loss and dyconjugate gaze
- global aphasia
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
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
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
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?
- medulla oblongata
- choroid plexus of 4th ventricle
- dentate nucleus
*this is the main supplier of blood to cerebellum
list S/S of Wallenburg’s syndrome
- Vertigo
- N/V
- Nystagmus
- Ataxia
- Balance and gait coordination problems
- Contralateral facial pain/temp loss
- 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?
- CN VI nucleus
- medial lemniscus
- pontine center
- vestibular nuclei
- middle cerebellar peduncle
- CST and corticobulbar tracts
List S/S of medial inferior pontine syndrome
- Ipsilateral to lesion
- paralysis of conjugate gaze
- nystagmus
- ataxia of limbs and gait
- diplopia on lateral gaze
- 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?
- CN V (sensory) nuclei
- CN VII nuclei
- CN VIII nuclei
- pontine center
- middle cerebral peduncle
- cerebellar hemisphere
list S/S of lateral inferior pontine syndrome
- Nystagmus
- vertigo
- N/V
- ipsilateral facial paralysis and sensory loss
- ipsilateral paralysis of conjugate gaze
- hearing loss, tinnitus
- ataxia
- 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
- acute hemiparesis that progresses to fully body tetraplegia
- lower bulbar paralysis (IV-XII involvement)
- upward eye movements and blinking are usually the only motor spared
- Mutism (loss of voice)
- cognition is spared
