Ischemic Strokes Flashcards
Left MCA
Right hemiplegia Right hemianesthesia Right homonymous hemianopsia (parietal and temporal optic radiations) Left gaze deviation Global aphasia
Right MCA
Left hemiplegia Left hemianesthesia Left homonymous hemianopsia Left hemineglect (can't recognize left side of body) Right gaze deviation
Left ACA
Right motor weakness (legs > arms)
Right sensory loss (legs > arms)
Abulia - frontal lobe behavioural abnormalities
Right ACA
Left motor weakness (legs>arms)
Left sensory loss (legs>arms)
Abulia
Left PCA
Right homonymous hemianopsia
Alexia without agraphia (if selenium of corpus callous involved)
If proximal PCA occluded (supply thalamus and midbrain):
- right hemisensory loss (thalamus)
- right hemiparesis (midbrain)
Right PCA
Left homonymous hemianopsia
If proximal PCA occluded:
- Left hemisensory loss (thalamus)
- Left hemiparesis (midbrain)
Top of the basilar stroke
Small perforating articles that supply thalamus and midbrain
- Decreased LOC*
- Dysarthria
- Visual field deficit
- Eye movement abnormalities
- Weakness
- Ataxia
- Numbness
Pontine Locked In Syndrome
Mid-basilar occlusion or pons hemorrhage
- Quadriplegia
- Can’t move eyes horizontally (PPRF)
- Bilateral facial weakness
- Anarthria
Lateral medullary syndrome
Vertebral arteries and PICA occlusion -Vertigo, nausea, dizziness -Dysphagia, dysarthria, hoarseness -Ipsilateral Horner's Syndrome -Ipsilateral ataxia -Ipsilateral facial numbness -Contralateral body numbness NO WEAKNESS
Medial medullary syndrome
Vertebral arteries and anterior spinal artery occlusion
- Contralateral hemiplegia
- Contralateral loss of vibration and proprioception
- Ipsilateral tongue weakness
Cerebellar strokes
Ataxia
Nystagmus
Dysarthria
Vertigo, nausea, vomiting
Mechanisms of ischemic stroke
Large artery atherosclerosis
Small vessel lacunar stroke
Cardioembolism
Monocular causes of amaurosis fugax
Carotid artery stenosis Giant cell arteritis Nonarteritic Anterior Ischemic Optic Neuropathy Retinal vasospasm Papilledema Ocular cause
Binocular causes of amaurosis fugax
Vertebrobasilar ischemia
Migraine with visual aura
Seizure
2 cases where you do NOT give TPA
Aortic Dissection
C-Spine Fracture
Sagittal sinus thrombosis
Weakness in lower extremities
Transverse sinus thrombosis
Often secondary to otitis media and mastoiditis in meds
CNVI palsy
Deep venous thrombosis
DECREASED LOC
Cavernous sinus thrombosis
Often septic - bacterial sinusitis and orbital cellulitis
Acute onset
CN palsies (esp CNIII)
Empty delta sign
CTA finding for sagittal sinus thrombosis
CTA finding for MCA
Hyper dense MCA
Hemorrhage imaging
- NCCT
2. CTA
Ischemia imaging
- CTP
- CTA
- NCCT
Ethology imaging
- CTA
2. NCCT
