Lecture 5: Cerebral Stroke Syndromes Flashcards
What two major arteries supply the brain with blood flow?
- internal carotid
2. Vertebral
What two major cerebral arteries come off of the internal carotid?
- anterior cerebral
2. middle cerebral
What major cerebral arteries come off of the vertebral?
Posterior cerebral artery from the basilar
What area of the brain does the ACA supply?
medial frontal and parietal lobes
What area of the brain does the MCA supply?
lateral frontal, parietal, temporal lobes
What areas of the brain does the PCA supply?
occipital lobe, medial and inferior temporal lobe, cerebellum, brainstem
What is ACA syndrome?
very uncommon, 3 % of strokes with clinical features of:
contralateral hemiplegia and hemianesthesia LE more than UE
Albulia- lack of will or initiative (prefrontal cortex)
Apraxia
L ACA will cause aphasia (SMA)
What is apraxia?
problems with motor planning and sequence
loss of connection between verbal and motor areas of the brain
What are the 5 different types of apraxia?
- ideomotor
- ideational
- Constructional
- Gait
- Verbal
What is an ideomotor apraxia?
damage in the left parietal lobe
inability to carry out a verbal motor command
What is ideational apraxia?
damage to bilateral parietal lobe
inability to create a plan for multistep movement plans
What is constructional apraxia?
damage usually in right parietal lobe
inability to draw pictures or construct simple configurations
What is gait apraxia?
damage in the frontal lobes
impaired gait but motor and sensory function intact
How can you differentiate between gait ataxia and apraxia?
compare cerebellar functions as ataxia will be from damaged of cerebellum
What is the most common site of occlusion in brain?
MCA as there is less collateral flow around it
the more proximal the occlusion the more damage
What are clinical features of a MCA occlusion?
CL hemiplegia UE then face then LE
- homonymous hemianopsia
- CL sensory loss usually UE
What other clinical features are also likely if damage is to dominate hemisphere?
typically left, then aphasia
What other clinical features are also likely if damage is to non-dominate hemisphere?
agnosia (can’t process sensory info), unilateral neglect, apraxia
What is homonymous hemianopsia?
loss of half of the field of view on the same side in both eyes because visual pathways are supplied by MCA
What is unilateral neglect?
inability to report, respond, or orient to stimuli in the CL space this is not due to sensory or motor deficits
Why does this unilateral neglect occur?
not well understood usually damage to R parietal lesion which will affect L side
Why is unilateral neglect such a big problem for PT?
anosognosia- failure to recognize deficits can lead to increase risk for falls and poorer functional recovery
What types of things can a patient neglect?
inputs- CL sights, smells, sounds, tactile stimuli
outputs- your own body or personal space, limb use but not due to NM ability
What are two types of visuospatial neglect?
egocentric and allocentric
What is egocentric neglect?
person never sees what is on their left side even if they shift perspective
won’t see coffee mug on left but if placed on right side will see whole thing
What is allocentric neglect?
person never sees left side of object no matter where it is placed in visual field
will literally only see half a mug regardless if on left or right side
How is unilateral neglect usually diagnosed?
observation of pt behavior,
various writing tests
What is the result of ICA syndrome?
usually massive infarction as it supplies both MCA and ACA
usually resembles MCA and leads to edema, coma or death
What are clinical features of PCA syndrome if thalamic branch involved?
if thalamic branch- CL hemianesthesia and thalamic pain (anything perceived as pain)
What are clinical features of PCA syndrome if unilateral occipital lobe is involved?
HH, visual agnosia, alexia with agraphia (can’t read but can write)
usually left side
What are clinical features of PCA syndrome if bilateral occipital is involved?
cortical blindness (due to visual cortex deficit)
What are clinical features of PCA syndrome if temporal lobe is involved?
memory deficits, amnesia
What is Weber’s syndrome?
unilateral midbrain infarction leads to paralysis of the IL oculomotor nerve causing ptosis, strabismus and loss of light reflex and accommodation
spastic hemiplegia on CL side
What is a complete basilar syndrome?
bilateral infarction of pons leads to locked in syndrome, tetraplegia, anarthria, come, 60% mortality rate
What is horner’s syndrome?
IL ptosis, mitosis, flushing of face and anhydrosis of face, dysphagia, dysphonia, diminished gag reflex, IL sensory impairments, CL impaired pain and temp
What is Wallenberg’s syndrome?
lesion of vertebral or PICA
CF: dysphagia, CL loss of pain or body temp, IL loss of pain and temp of face, vertigo, nystagmus, IL loss of taste
What is a lacunar infarction?
stroke in one of small vessels off circle of wills, MCA, Vertebral or basilar arteries
What is etiology of lacunar infarction
chronic HTN and DM
good prognosis account for 20% of all strokes
What if there is a lacunar infarction of posterior limb of internal capsule, pyramid or pons?
pure motor hemi
What if there is a lacunar infarction of ventrolateral thalamus or projections?
pure sensory stroke
What if there is a lacunar infarction of base of pons?
ataxic hemi and dysarthria
What if there is a lacunar infarction of anterior limb of internal capsule and corona radiate?
pure motor hemi w/ apraxia
What if there is a lacunar infarction of putamen and globus pallidus?
dystonia and choreoathetosis
What are functions of left side of frontal lobe?
motor, initiation, judgment and expressive language
What are functions of right side of frontal lobe?
motor, initiation, judgment and emotions and creativity
What are functions of left side of parietal lobe?
sensation, reading, writing, numbers
What are functions of right side of parietal lobe?
sensation, visual perception and spatial orientation (unilateral neglect)
What are functions of left side of temporal lobe?
hearing, word memory and language comprehension
What are functions of right side of temporal lobe?
hearing music non verbal memory
What is left side of brain generally used for?
logic, methodical , analytical
What is right side of brain generally used for?
creative, artistic
What are general characteristics of a patient with a Left side CVA?
right hemi, slow cautious, insecure, better insight, memory problems, aphasia, motor apraxia, right hemianopsia
What are general characteristics of a patient with a right side CVA?
left hemi, quick impulsive, poor judgment, unilateral neglect, left hemianopsia, apraxia
