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Neuromuscular System Evaluation and Management > Lecture: CVA Syndromes > Flashcards

Lecture: CVA Syndromes Flashcards

1
Q

CVA syndromes

A
  • MCA
  • ACA
  • PCA
  • IC
  • Vertebral
  • Basilar
  • Cerebellar
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2
Q

Anterior Cerebral Artery Syndrome***

A

Supplies: medial cerebral hemisphere (frontal & parietal lobes) & subcortical structures

If the dominant language hemisphere is affected, ABULIA and a reduction in the rate or complexity of language & speech results. The severe
form of abulia is termed AKINETIC MUTISM

  • Contralateral LE > UE* affected by paresis and sensory loss
  • Memory and behavioral impairments
  • Non-dominant side damage : unilateral neglect
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3
Q

Middle Cerebral Artery Occlusion***

A
  • Generally embolic more often than thrombic!
  • Most often occluded artery as a result of vascular disease
  • Supplies the entire lateral surface/cerebral hemisphere of the brain (fronto-temporo-parietal)

Results in
• Contralateral spastic hemiparesis
• Contralateral hemianesthesia
• Homonymous hemianopsia with impairment of conjugate gaze in the direction opposite the lesion

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4
Q

Homonymous Hemianopsia

A

Loss of the temporal visual field from one eye & the nasal visual field of the other eye.
• R occipital lobe damage -> loss of L visual field
• L occipital lobe damage -> loss of R visual field

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5
Q

MCA Occlusion: effect on hemispheres

A
  • If the (L) hemisphere is involved (and is language dominant) -> global aphasia (Severe aphasia of both production & comprehension, Poor reading & auditory comprehension, repetition, naming, & writing)
  • If the non-dominant (typically (R) side) hemisphere is affected, esp. in the parietal lobe, it will result in perceptual deficits
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6
Q

MCA upper division occlusion

A

Upper division MCA involvement of dominant/L hemisphere of frontal lobe-> Broca’s aphasia (Awkward articulations, restricted vocabulary, restriction to simple
grammatical forms, Comprehension is intact, Reading is less impaired than speech & writing.
“D—d—d—dg, eh, no…d-d… darn…p-p-pet”

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7
Q

Lower Division MCA Occlusion

A

auditory association complex of lateral temporal lobe
-> Wernicke’s aphasia (Loss of auditory comprehension, poor command following, Loss of ability to read & write,Fluent speech but lack content or meaning.)

Question: “How are you today?”
Answer: “When? Easy for my river runs purple boxes wizzel abata Hon when goobles come.”

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8
Q

Conduction Aphasia

A

Results from interruption in connections between Broca’s &Wernicke’s areas
• Presents like Wernicke’s aphasia, but with good comprehension & understands your commands
• Poor repetition, naming, & writing

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9
Q

Internal Carotid Artery Syndrome

A

due to hypoperfusion, embolus or thrombus

Amaurosis Fugax (Transient monocular blindness) is a frequent accompanying symptom
• Temporary fading of vision or blindness
• Due to ↓ blood supply from the ICA to the opthalmic artery

Supplies both MCA & ACA
• Complete blockage without adequate collateral circulation will result in deficits in both MCA & ACA!

Significant edema is common w/ possible uncal herniation, coma, &death

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10
Q

Posterior Cerebral Artery Syndrome : Supplies and branches

A

Supplies: occipital lobe, medial/inferior temporal lobe, upper brainstem, midbrain, posterior diencephalon, & thalamus

Two branches:
• Central vs. Peripheral Branch

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11
Q

Central PCA Syndromes (good way to remember is THC)

A

Thalamic Pain Syndrome- a lot of pain from stimulus that is usually not painful, happens post 1 month hemisensory loss recovery

Hemiballismus- Movement disorder typified by flinging, flailing movements of one extremity

Contralateral hemiplegia from cerebral peduncle involvement (if accompanied by CNIII palsy, then Weber’s Syndrome)

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12
Q

Peripheral PCA Syndromes

A

Transient Global Amnesia (TGA)
• hippocampal lesion

Dyslexia w/o agraphia; color naming & discrimination problems

Visual symptoms - occipital lobe lesions ( Remember, hemianopsia, prosopagniosa, topographic disorientation has something to do with vision)

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13
Q

Cerebellar lesion symptoms

A

Superior Cerebellar artery-vestibular
Inferior Cerebellar artery- face,dysphagia

Direction-changing nystagmus
• Nystagmus: rapid involuntary rhythmic eye movement with the eyes moving quickly in one direction (quick phase), and then slowly in the other (slow phase).

  • Dizziness
  • Nausea/Vomiting
  • Ipsilateral ataxia

Sensory changes: decreased light touch, vibration, position sense
UE more impacted than LE

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14
Q

Anterior Inferior Cerebellar Artery (AICA) syndrome

A

Lateral Pontine Syndrome
Vestibular: sudden onset vertigo, vomiting, nystagmus
Motor: ipsilateral ataxia, falling to ipsilateral side, ipsilateral face paralysis
Sensory: ipsilateral loss of facial sensation, ipsilateral hearing loss and tinnitus, contralateral loss of pain and temperature

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15
Q

Basilar Artery Syndrome

A

Supplies: Pons, portions of the
midbrain, cerebellum and diencephalon
CN 4-8

• Can be catastrophic because of (B) pontine damage

  • Coma
  • Locked in syndrome- paralysis except for eyes
  • Akinetic mutism

Tetraplegia (bilateral corticospinal tract lesions)

Poor prognosis

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16
Q

Vertebral Artery Syndrome

A

VA is the primary arterial supply to the medulla & posterior-inferior cerebellum, CN 9-12

Most commonly occluded by atherosclerosis, but is susceptible to trauma, such as MVA or inappropriate extension - rotation manipulations!

17
Q

Posterior Inferior Cerebellar Artery (PICA) Syndrome AKA

A

Wallenberg’s (Lateral Medullary) Syndrome

Lateral Medullary Syndrome = Wallenberg Syndrome = PICA Syndrome

Vestibular: Nystagmus, nausea/vomiting, vertigo

Motor: ipsilateral UE/LE ataxia, gait ataxia, dysphagia, dysarthria

Sensory: contralateral loss of pain and temperature of the body, ipsilateral loss of pain and temperature of the face, ipsilateral Horner’s syndrome

18
Q

Ischemic vs Hemorrhagic CVA recoveries

A

Ischemic CVAs
• Better survivability, but poorer functional recovery

Hemorrhagic CVAs
• poorer survivability, but better functional recovery

19
Q

Factors of recovery

A
  • Reduction of swelling or edema
  • Existence of collateral blood flow
  • Neuroplasticity
20
Q

Hemorrhagic CVA types and causes

A

Most common types are
• Intracerebral Hemorrhage (ICH) due to HTN or cerebral amyloid angiopathy (CAA- natural protein from aging)
• SAH due to ruptured aneurysm or AVM

Other causes:
• Hyper-anticoagulation
• Hemorrhage from brain tumor
• Trauma (such as TBI)
- ETOH
21
Q

Hemorrhagic CVA syndromes (CPPT or Cool PowerPoinT)

A

Putaminal Hemorrhage
• Similar to MCA stroke, but with greater alteration of consciousness

Thalamic Hemorrhage
• Results in contralateral hemiplegia with disproportionately greater sensory loss!

Cerebellar Hemorrhage
• Results in ataxia and vestibulopathy

Pontine Hemorrhage
Offers the poorest prognosis
• Tetraplegia and coma

22
Q 
Intracerebral Hemorrhage (ICH)-
evolution
symptoms
the two types
Prognosis
A

gradual & steady evolution! that occurs over minutes,
hours and days, some are sudden onset

severe HA, vomiting and seizures at onset

Primary ICH
• A spontaneous bleed, and is usually due to microvascular disease associated with HTN and/or aging
• Small penetrating arteries are the most frequently involved

Secondary ICH
Occurs due
• Trauma
• Impaired coagulation
• Toxic exposure
23
Q

Intracerebral Hemorrhage (ICH)-

Prognosis

A

Most fatal of all CVA subtypes

Prognosis for recovery from ICH is greater because lesions are characterized by compression as opposed to tissue destruction
The expanding lesion causes significant ↑ in HTN, and can be fatal due to the compression of vital centers

24
Q

Medical Intervention for ICH

A
  • Lowering of BP into the normal range via anti-hypertensive medications
  • Treatment of cerebral edema - steroids, mannitol
  • Anticonvulsants if seizures are present
25
Q

SAH-
where
Most common sites
Most common cause

A

subarachnoid space between the arachnoid & the
pia mater

Most common sites
• Anterior communicating artery
• Posterior communicating artery
• Middle cerebral artery
-bones of the orbit and posterior fossa

Aneurysms
Other causes: vascular malformations, trauma, infection

26
Q

Aneurysm: Surgical Interventions

A

Surgical Clipping- Craniotomy & clipping at “neck”

Endovascular Coiling
• Catheter up femoral artery - aorta - aneurysm
• Platinum coils - thrombotic reaction - blocks flow & prevents rupture

27
Q

Dangers of SAH

A

Susceptibility to re-rupture
• Obstruction of the SA space which can lead to hydrocephalus due to CSF blockage

Blood in SA space may lead to:
• Vasospasm: resulting in ischemic infarction of the adjacent vessels
• Inflammatory and fibrotic responses in the meninges
• These secondary complications often prove fatal

28
Q

SAH severity levels

A
  • Mild is often associated with stiff neck, mild HA, and confusion lasting for weeks
  • Moderate is associated with mild coma, moderate to severe HA
  • Severe can be fatal, and is associated with severe HA, decerebrate rigidity and deep coma

Risk of re bleeding in mod and severe lvls

29
Q 
Arteriovenous Malformation (AVM)
Process
symptoms
cause
hemorrhages location
prognosis
A

Is the result of abnormal fetal development

High pressure arteries connect directly to low pressure veins instead of through capillaries.

Lack of O2 or glucose -> tiny hemorrhages presenting as HA

focal deficits may occur as a result of shunting away of
blood from healthy brain into the fistula (cerebral steal syndrome)

30
Q

Arteriovenous Malformation (AVM)

hemorrhages location
prognosis

A

Hemorrhages can be parenchymal or subarachnoid

Prognosis is good, surviving the 1st bleed

31
Q

cerebral steal syndrome

A

Arteriovenous Malformation causing focal deficits may occur as a result of shunting away of
blood from healthy brain into the fistula
(cerebral steal syndrome)

32
Q

AVM: Treatments

A
  • Radiation - indicated for very small & deep AVM’s
  • Embolization - indicated for larger AVM’s. Angiogram then coils, balloons, etc.
  • Surgery - total cure. complete resection, thus disallowing them from ever recurring again.
33
Q

Medical Intervention for SAH/AVM

A

Surgery is the treatment of choice
• Craniotomy and evacuation
• Craniectomy and evacuation if ICP is abnormally high

34
Q

Lacunar CVA
Location
Syndromes

A

Occurs in the deep white matter of the brain

Syndromes tend to be either
• Pure motor (internal capsule-posterior limb)
• Facial weakness (internal capsule-anterior limb)
• Pure sensory (posterolateral thalamus)

Neuromuscular System Evaluation and Management (21 decks)

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