CVA (Part II) Flashcards
CVA (Part II)
What are the main CVA vascular syndromes covered?
ACA, MCA, PCA, ICA, Lacunar Strokes, Vertebrobasilar Artery Syndrome, Cerebellar Strokes.
Why is it important to know the different CVA vascular syndromes?
To anticipate patient presentation and for board exams.
What does the side of CVA refer to?
The side of the lesion in the brain.
Which CVA syndrome is most common?
MCA syndrome.
What are the common differences between left and right MCA syndromes?
- Left MCA: aphasia, language apraxia, dysarthria, cautious behavior.
- Right MCA: left neglect, denial of deficits, impulsive behavior.
Describe the clinical presentation of Anterior Cerebral Artery (ACA) syndrome.
- contralateral hemiparesis LE > UE
- contralateral hemisensory loss LE > UE
- urinary incontinence
- apraxia
- slowness
- contralateral grasp and sucking reflex
What are the symptoms of ACA syndrome?
- LE symptoms worse than UE
- apraxia
- motor inaction
- slowness
- urinary incontinence
- grasp and sucking reflexes
Describe the clinical presentation of Middle Cerebral Artery (MCA) syndrome.
- contralateral hemiparesis UE and face > LE
- contralateral hemisensory loss UE and face > LE
- aphasia
- perceptual deficits
- contralateral homonymous hemianopsia
- loss of conjugate gaze
- ataxia
- apraxia
What are the symptoms of MCA syndrome?
- UE and face symptoms worse than LE
- Contralateral hemiparesis UE and Face > LE
- Contralateral hemisensory loss UE and Face > LE
- Broca’s aphasia (Dominant in L hemisphere)
- Wernicke’s aphasia (dominant in L hemisphere)
- Global aphasia: non-fluent speech with poor comprehension
- Perceptual deficits and neglect (Dominant R hemisphere)
- Contralateral homonymous hemianopsia
- Loss of conjugate gaze (the ability of eyes to work together) to the opposite side
- Ataxia of contralateral limbs (Sensory ataxia)
- Apraxia
Describe the clinical presentation of Posterior Cerebral Artery (PCA) syndrome (peripheral territory).
- contralateral homonymous hemianopsia
- bilateral homonymous hemianopsia
- visual agnosia
- prosopagnosia
- dyslexia
- memory defect
- topographic disorientation
- figure-ground discrimination
Describe the clinical presentation of Posterior Cerebral Artery (PCA) syndrome (central territory).
- central post-stroke (thalamic) pain
- involuntary movements
- intention tremor
- contralateral hemiplegia
- paresis of vertical eye movements
- Weber’s syndrome
Describe the clinical presentation of Internal Carotid Artery (ICA) syndrome.
- massive infarction in region supplied by MCA
- extensive infarction in ACA and MCA territories if no collaterals from circle of Willis
- symptoms of MCA involvement
- reduced consciousness
- possible brain herniation and death
Describe lacunar strokes and their typical presentation.
- small vessel disease deep in white matter
- deficits depend on area affected
- can observe pure motor
- pure sensory
- ataxia/dystonia
- higher cortical areas preserved (consciousness, language, visual fields)
Describe the clinical presentation of Vertebrobasilar Artery syndrome.
Wide variety of symptoms, includes
- medial and lateral medullary syndrome
- medial and lateral inferior pontine syndrome
- basilar artery syndrome
- PCA syndrome
What are the medial brainstem structures involved in brainstem syndromes?
- Motor pathway
- Medial lemniscus
- Medial longitudinal fasciculus
- Motor CN nucleus (3, 4, 6, or 12)
What are the lateral brainstem structures involved in brainstem syndromes?
- spinocerebellar pathways
- spinothalamic pathway
- sympathetic pathway
- sensory nucleus of CN V
What are the cranial nerves associated with the brainstem levels?
- Above pons: I – IV
- Pons: V – VIII
- Medulla: IX – XII
What are the clinical findings in medial medullary syndrome?
- ipsilateral paralysis of ½ of tongue
- contralateral hemiplegia UE/LE
- impaired sensation
What are the clinical findings in lateral medullary syndrome?
- cerebellar symptoms
- loss of pain and temperature sensation in face (ipsilateral)
- loss of pain and temperature over body and sometimes face (contralateral)
- horners syndrome (sometimes)
What are the clinical findings in medial inferior pontine syndrome?
- ipsilateral nystagmus
- paralysis of conjugate gaze to side of lesion
- diplopia on lateral gaze
- contralateral hemiparesis UE/LE
- impaired sensation
What are the clinical findings in lateral inferior pontine syndrome?
- ipsilateral cerebellar ataxia
- nystagmus
- vertigo
- facial paralysis
- paralysis of conjugate gaze to side of lesion
- deafness
- tinnitus
- impaired facial sensation
- contralateral impaired pain and temperature sensation half of body
Describe the clinical findings and symptoms of Locked-in syndrome.
- tetraplegia
- lower bulbar paralysis (CN V-XII)
- mutism
- preserved consciousness
- preserved sensation
- preserved vertical eye movements and blinking
What are the characteristics of cerebellar strokes?
- ataxia
- incoordination
- intention tremors
- dysarthria
- hypo-reflexia
What are the 4 structures in the midline beginning with ‘M’?
- motor pathway (corticospinal tract)
- medial lemniscus
- medial longitudinal fasciculus
- motor CN nucleus (3, 4, 6, or 12)
What are the 4 structures to the side beginning with ‘S’?
- spinocerebellar pathways
- spinothalamic pathway
- sympathetic pathway
- sensory nucleus of CN V
Describe Horner’s syndrome and its symptoms.
Occurs due to disruption of sympathetic pathways
- ptosis
- miosis
- anhydrosis
What is visual agnosia, and how is it tested?
Visual Agnosia:
- Inability to recognize familiar objects with one sensory modality while retaining ability to recognize same object with other sensory modalities.
- Tested by asking to identify objects by sight and another sense.
Describe the clinical findings in Weber’s syndrome.
Weber’s Syndrome: Ipsilateral oculomotor nerve palsy and contralateral hemiplegia.
Describe the clinical findings in medial medullary syndrome.
- Ipsilateral tongue paralysis
- contralateral hemiplegia
- impaired sensation
Describe the clinical findings in lateral medullary syndrome (Wallenberg’s syndrome).
- cerebellar symptoms (ataxia, vertigo, nausea, nystagmus)
- loss of pain and temperature sensation in face (ipsilateral)
- loss of pain and temperature over body and sometimes face (contralateral)
- Horner’s syndrome
Describe the clinical findings in medial inferior pontine syndrome.
- ipsilateral nystagmus
- paralysis of conjugate gaze to side of lesion
- diplopia on lateral gaze
- contralateral hemiparesis UE/LE
- impaired sensation
Describe the clinical findings in lateral inferior pontine syndrome.
- Ipsilateral cerebellar ataxia
- nystagmus
- vertigo
- facial paralysis
- paralysis of conjugate gaze to side of lesion
- deafness
- tinnitus
- impaired facial sensation
- contralateral impaired pain and temperature sensation half of body
What is the significance of the ‘rule of 4’ in brainstem syndromes?
It helps in understanding and diagnosing brainstem vascular syndromes by categorizing structures and cranial nerves.
What are the most common CVA vascular syndromes?
- MCA
- PCA
- ACA
- vertebrobasilar
- ICA
- cerebellar
What are the typical symptoms of PCA syndrome in the peripheral territory?
- Visual and memory deficits
- contralateral homonymous hemianopsia
- Bilateral homonymous hemianopsia
- visual agnosia
- prosopagnosia
- dyslexia
- topographic disorientation
- figure-ground discrimination
What are the typical symptoms of PCA syndrome in the central territory?
- Central post-stroke pain
- involuntary movements
- intention tremor
- contralateral hemiplegia
- paresis of vertical eye movements
- Weber’s syndrome
What are the clinical findings in Locked-in syndrome?
- tetraplegia
- lower bulbar paralysis
- mutism
- preserved consciousness
- preserved sensation
- preserved vertical eye movements and blinking
What are the characteristics of cerebellar strokes?
- Ataxia
- incoordination
- intention tremors
- dysarthria
- hypo-reflexia
