Neuromuscular: Cerebral Vascular Accident: Types and Manifestation

Question 1

Stroke

Answer 1

Occurs when the blood supply to the brain is interrupted or reduced

Question 2

Stroke: Categories: Ischemic Stroke: Cerebral Thrombosis

Answer 2

Formation of or development of a blood clot or thrombus within the cerebral arteries or their branches

Question 3

Stroke: Categories: Ischemic Stroke: Cerebral Embolism

Answer 3

Traveling bits of matter that produce occlusion, and infarction in the cerebral arteries

Question 4

Stroke: Categories: Hemorrhagic Stroke

Answer 4

Abnormal bleeding as a result or rupture of a blood vessel

• Extradural
• Subdural
• Subarachnoid
• Intracerebral

Question 5

Stroke: Categories: Transient Ischemic Attack

Answer 5

A temporary period of symptoms resulting from decreased blood supply to the brain, there is no permanent damage

Question 6

Stroke: Risk Factors

Answer 6

• Atherosclerosis
• Hypertension
• Cardiac Disease
• Diabetes
• Transient Ischemic Attacks

Question 7

Stroke: Pathophysiology

Answer 7

Cerebral Anoxia: Lack of oxygen supply to the brain

Question 8

Stroke: Location: Middle Cerebral Artery: Main Characteristics

Answer 8

• Contralateral hemiplegia of the face
• Contralateral Hemiplegia of the limbs with hemiplegia of the upper extremity more severe than the lower extremity.
• Homonymous Hemianopsia

Question 9

Stroke: Location: Middle Cerebral Artery: Other Characteristics Not Always Present

Answer 9

• If left hemisphere is involved then, Motor speech involvement in the form of fluent, non fluent, global, or conduction aphasia.
• If right hemisphere involvement then, perceptual deficits, loss of conjugate gaze, and sensory ataxia.

Question 10

Stroke: Location: Anterior Cerebral Artery: Main Characteristics

Answer 10

• Contralateral Hemiplegia of the limbs with lower extremity being more involved than upper extremity.
• Contralateral hemisensory loss with lower extremity being more involved than upper extremity.
• Urinary incontinence
• Problems with bimanual tasks
• Apraxia

Question 11

Stroke: Location: Anterior Cerebral Artery: Other Characteristics Not Always Present

Answer 11

• Patients may be less mobile

- Patients may be less verbal

Question 12

Stroke: Location: Posterior Cerebral Artery: Main Characteristics

Answer 12

• Contralateral sensory loss
• Involuntary movements: Choreathetosis, tremor, hemiballismus
• Transient contralateral hemiparesis
• Homonymous Hemianopsia

Question 13

Stroke: Location: Posterior Cerebral Artery: Other Characteristics Not Always Present

Answer 13

• Visual agnoisa
• Memory deficit
• Dyslexia
• Central Pain
• Weber’s Syndrome
• Oculomotor Palsy
• Aphasia
• Thalamic pain
• Hemiplegia if cerebral peduncle of midbrain is involved.

Question 14

Stroke: Location: Lacunar: Main Characteristics

Answer 14

• Contralateral hemiplegia upper extremity and lower extremity

Question 15

Stroke: Location: Lacunar: Other Characteristics

Answer 15

• Aphasia is not present

- Visual field deficits are rare

Question 16

Stroke: Location: Midbrain Lesion: Main Characteristcs

Answer 16

• Contralateral hemiplegia

Question 17

Stroke: Location: Midbrain Lesion: Other Characteristics Not Always Present

Answer 17

• Contralateral Cranial nerve III Palsy

Question 18

Stroke: Location: Vertebral Basilar: Main Characteristics

Answer 18

• Often results in death from the edema associated with the infarct
• If the patient survives and and the lesion affected the pons, the result could be quadripaesis and bulbar palsy, or a “locked in” state where the patient can communicate only by eye blinking.
• Other symptoms can include vertigo, coma, diplopia, nausea, dysphagia, ataxia, and various cranial nerve impairments.

Question 19

Stroke: Location: Medial Inferior Pontine Syndrome

Answer 19

• Ipsilateral to lesion:
  - Cerebellar ataxia, nystagmus
  - Paralysis of conjugate gaze to side of lesion
  - Diplopia
• Contralateral to lesion:
  - Hemiparesis UE and LE
  - Impaired sensation

Question 20

Stroke: Location: Lateral Inferior Pontine Syndrome

Answer 20

• Ipsilateral to lesion:
  - Cerebellar ataxia, nystagmus, vertigo
  - Facial paralysis
  - Paralysis of conjugate gaze to the side of the lesion.
  - Deafness and tinnitus
  - Impaired facial sensation
  Contralateral to lesion:
  
  • Impaired pain and temperature sensation to contralateral half of the body.

Question 21

Stroke: Location: Locked in Syndrome

Answer 21

• Tetraplegia
• Lower Bulbar Paralysis (CN V-XII)
• Mutism
• Preserved consciousness
• Preserved vertical eye movements and blinking

Question 22

Stroke: Location: Medial Medullary Syndrome

Answer 22

• Ipsilateral to lesion:
  - Paralysis to half of tongue
• Contralateral to lesion
  - Hemiplegia UE and LE
  - Impaired sensation

Question 23

Stroke: Location: Lateral Medullary Syndrome

Answer 23

• Ipsilateral to lesion:
  - Cerebellar symptoms
  - Loss of pain temperature to face
  - Sensory Loss UE, trunk, or LE
• Contralateral to lesion:
  - Loss of paining temperature to body and face
• Other:
  - Horner’s Syndrome
  - Impaired speech

Question 24

Stroke: Location: Anterior Inferior Cerebellar

Answer 24

• Deafness on contralateral side
• Loss of pain ad temperature on contralateral side
• Paresis of lateral gaze
• Horner’s Syndrome on contralateral side
• Ataxia
• Vertigo
• Nystagmus

Question 25

Stroke: Location: Superior Cerebellar

Answer 25

• Severe Ataxia
• Dysarthria
• Dysmetria
• Contralateral loss of pain and temperature

Question 26

Stroke: Location: Posterior Inferior Cerebellar

Answer 26

• Wallenberg’s Syndrome
  - Vertigo
  - Nausea
  - Hoarseness
  - Dysphagia
  - Ptosis
  - Decreased impairment of sensation in ipsilateral face and contralateral torso and limbs.
• Horner’s Syndrome may also appear.