Norden - Stroke Flashcards
A small infarcted area, it may occur from occlusion of a small end artery
Lacunar infarct
Occurs between the distribution of two major arteries
Watershed infarct
Insufficiency of blood supply to some area of the brain
Stroke
Stroke where the vessel ruptures and bleeds. Accounts for 10-15% of strokes.
Herniation is possibility
Hemorrhagic stroke
Area of tissue death
Necrosis
Area of necrosis in the brain
Infarction
an absence of willpower or an inability to act decisively, as a symptom of mental illness.
Abulia (seen in ACA stroke) [will also be seen in ALZ]
medical term describing patients tending neither to move (akinesia) nor speak (mutism).
Akinetic mutism (seen in ACA stroke)
A tia involving the opthalmic artery that produces a temporary or transient ipsilateral blindness
Amaurosis fugax
What is a small vessel stroke?
Stroke of branches that supply deep structures in the hemispheres.
PCA; basal):
•Contra spastic paresis/paralysis (body below the neck) with a Babinski; contra lower facial paresis/paralysis
•Ipsi oculomotor ophthalmoplegi
Weber’s Syndrome
ontra tremor upper limb and ipsi oculomotor ophthalmoplegia
Claude’s Syndrome (PCA OR BASILAR; tegmental)
Weber’s and Claude’s Syndrome
Benedikt’s syndrome (basilar)
A “brain attack” brought about by an acute impairment of CNS blood supply
Stroke
Why are hemorrhagic strokes especially dangerous/
The hemorrhage and resulting clot take up space in the brain and can lead to herniation and death
Rf’s for hemorrhagic stroke
HTN
Atherosclerosis
Diabetes
Other systemic and chronic disorders
A vessel is occluded by plaque, constituents of blood, or foreign matter. Account for about 85% of all strokes
Ischemic stroke
Most ischemic strokes are __
Thrombotic
Neurons which undergo anoxia and infarction take on which staining pattern ?
Dead reds (pathognomonic for ischemic stroke)
Acute, transient neurological episode caused by ischemia which normally returns to normal w/in 30 minutes.
TIA
___% of people w/ TIA’s ill go on to have a major stroke w/in 3 years.
80
Ischemic strokes can set off a _____ _____ which is when excess amounts of glutamate are released and accumulated in the interstitial space and leads to the influx of calcium which in term damages neurons that weren’t originally damage from the ischemia
Excitotoxic cascade
What type of edema can an ischemic stroke lead to ?
Cytotoxic edema ( from excitotoxic cascade )
Cortical strokes are ___ vessel strokes
Large vessel
Sudden transient loss of vision on one side resulting from occlusion of the central retinal artery
Amaurosis fugax
Global aphasia
Ipsilateral visual loss
Contralateral spastic paralysis w/ babinski
Loss of contralateral fine touch, vibration, conscious proprioception
Paralysis of lower face (UMN of VII)
Stroke of ICA
What stroke causes:
Contralateral; spastic paralysis/paresis w/ Babinski, loss of fine touch, vibration, and conscious proprioception, loss of ability to localize pain, lower face paralysis
Lenticulostriate stroke
Knocks out genu and posterior limb of internal capsule
Strokes within the brainstem never present with?
Visual field defects or with cortical signs
What are the 3 major stroke syndromes that occur in the midbrain at the level of the superior colliculus?
Weber’s syndrome
Benedikt’s syndrome
Claude’s Syndrome
What is the most common cause of Weber’s Syndrome?
Stroke of the penetrating branches of the PCA
What are the symptoms of weber syndrome and what causes it?
Contralateral: paralysis/paresis of body below neck, with a babinski
Contralateral: lower face paralysis / paraesis
Ipsilateral: Occulomotor opthalmoplegia
What happens in Claude’s Syndrome
A stroke involving small branches of either the PCA or
basilar that supply only the midbrain tegmentum; signs/symptoms will include
contralateral tremor (primarily of upper limb; from involvement of the red
nucleus) and ipsilateral oculomotor ophthalmoplegia
Describe what happens in Benedikt’s syndrome
Results most commonly from strokes involving penetrating
branches of the basilar artery; involves the basal and tegmental areas of the
midbrain; signs/symptoms are a combination of Weber’s and Claude’s syndromes
a patient
may show ipsilateral sensory loss in the face (Why? What reflex or reflexes might you test – and what would you expect to see?) and contralateral loss of fine touch, vibration, proprioception and pain sensation (of the body below the neck; Why?)
Tegmentum of rostral pons
What stroke syndrome will have a contralateral paralysis/paresis with a babinski (body below neck) and spastic paralysis of lower face ``
Stroke of rostral basal pons
What symptoms does a stroke in the caudal pons tegmentum have ?
It will involve facial colliculus, so ipsilateral paralysis/paresis of entire side of face. Ipsilateral medial strabismus.
A bilateral syndrome of the basal pons which can occur 2nd to a stroke involving basilar artery.
Pt appears to be in coma but is not comatose.
Pt is awake and alert, but entirely paralyzed except for vertical eye movement and sometimes eyelid movement
Locked-in syndrome
What are the only movements that are intact in locked in syndrome ?
Vertical eye movements and Sometimes eyelid movement
Strokes involving the upper part of the basilar where it divides into the two PCA arteries can result in ?
Significant memory impairment
Locked-in syndrome is due to bilateral basal pons damage following a stroke involving
The basilar artery
Strokes involving the medulla are?
Medial medullary syndrome
Wallenberg’s syndrome
The artery involved in Wallenberg’s syndrome (lateral medullary syndrome )
PICA
Supplies the dorsolateral medulla
Wallenberg’s syndrome (also called the lateral medullary syndrome or
PICA syndrome): occurs from strokes involving branches of the posterior inferior cerebellar artery (PICA), which supplies the dorsolateral area of the medulla; because of the areas supplied (Fig. 8), the patient presents with a characteristic constellation of signs/symptoms including:
1) Contralateral signs/symptoms: Loss of pain and temperature in the body
below the neck (because of involvement of the lateral spinothalamic tract
which carries pain and temperature information (Why is the loss
contralateral?); Note the importance of knowing where and when pathways
cross or decussate as they ascend in the brainstem!
2) Ipsilateral/other signs/symptoms: Loss of pain and temperature in the
face (Why?); vertigo, nystagmus, nausea and vomiting (from involvement
of vestibular nuclei), ataxia (from involvement of the inferior cerebellar
© 2017 Jeanette J. Norden per Legacy Law Group, Nashville, TN
Norden, Jeanette J. peduncle), and a Horner’s syndrome (consisting of the triad of miosis [pupillary constriction], ptosis [lid droop], and anhydrosis [decreased sweating of the face]) because of the involvement of sympathetic fibers which course through this area of the medulla; a weak or absent gag reflex, dysphonia (difficulty speaking; voice may be hoarse) dyspnea (difficulty breathing) and dysphagia (difficulty swallowing) - all due to involvement of the nucleus ambiguus
What artery causes medial medullary syndrome ?
Middle medullary artery (branch of vertebral)
What is hit in middle medullary syndrome ?
Medial lemniscus
Pyramid
LMN of XII
What symptoms arise in medial medullary syndrome ?
Tongue deviation towards side of lesion
Loss of contralateral fine touch, proprioception, and vibration, below level of lesion.
Contralateral spastic paralysis below the level of the lesion, with a babinski.
