Physiological Psychology Lecture #7 (Guest Lecture-Strokes) Flashcards
Stroke
An interruption of normal blood flow to the brain.
- Leading cause of disability in adults.
- Third leading cause of mortality above ages 60-65
- Risk increases multifold with age.
Angiography
basilar tip aneurysm, source of hemorrhage.
Subarachnoid Hemorrhage
Sudden onset of severe headache with/without nausea/vomiting.
- Prodrominal headache from minor blood leakage reported in 30-50% of aneurysmal SAHs.
- Photophobia and visual changes.
- Seizures in >25% of patients close to onset.
Ophthalmologic Signs in Subarachnoid Hemmorrhage
Retinal hemorrhage, papilledema.
Meningeal Signs in Subarachnoid Hemorrhage
- Seen in over 75% of SAH
- Neck stiffness, low back pain, bilateral leg pain.
- May take several hours to develop.
Loss of Consciousness Subarachnoid Hemmorrhage
About 50% of patients experience this at the time of bleeding onset.
- Due to transient inter-cranial circulatory arrest.
- The “percussive” blood pressure impact of the hemorrhage increase ICP (intercranial pressure) and therefore reduce CPP (cerebral perfusion pressure).
Hunter-Hess Grade 1
Asymptomatic of minimal headache and slight nuchal rigidity.
-11% mortality rate.
Hunter-Hess Grade 5
Deep coma, decerebrate rigidity.
- 100% mortality
Middle Cerebral Artery (MCA) Ischemic Stroke
Contralateral weakness (face = trunk = arm = leg).
- posterior limbs of internal capsule, primary motor, and premotor cortex.
- Contralateral cortical sensory loss (parietal sensory cortex).
- Homonymous hemianopsia or quandrantanopia (optic radiation)
- Gaze preference (frontal eye fields)
- Dysphagia (motor strip)
MCA Non-Dominant
- Contralateral neglect and anosagnosia (parietal association cortex)
- Visuospatial distortions (parieto-occipital association cortex)
- Aprosody (front-temporal and temporo-parietal cortex)
- Apraxias (acute confusional state with agitated delirium).
MCA Dominant
- Global aphasia (fronto-temporal and temporo-parietal cortex)
- Apraxia.
Aphasia
Caused by stokes in the left side of the brain that controls speech and language.
Hemiplegia
Paralysis affecting one side of the body (face, arm, trunk, leg)
Hemiparesis
Implies a lesser degree of weakness than hemiplegia.
Neglect
Failure to attend to, respond to, and/or report.
- Stimulation that is introduced contralateral to the lesion.
-Most often seen with non-dominant parietal association are lesions.
- Affects contralesional side.
- Persistent neglect is a negative functional outcome predictor.
Apraxia
Loss of ability to execute skilled or learned movement patterns of command.
- In the absence of weakness, sensory loss, comprehension difficulty, abnormality of tone of posture, or cognitive deficit/decline.
- Many types of apraxia.
- Multiple sites of possible injury.
- Test by shaking someone’s hand–may be able to shake the hand but will not be bale to release the hand.
Ideomotor Apraxia
plan for the movement is intact, but the execution fails.
ACA Syndrome
Unilateral:
- Leg > arm motor loss (up to 90% of patients)
- Leg > face = arm cortical sensory loss
- Frontal release signs/inhibition of reflexes.
Agnosia
Acquired inability to associate a perceived unimodal stimulus (visual, auditory, tactile) with meaning.
- Disorder of recognition (not naming)
Anosagnosia
Denial od deficit
Prosopagnosia
Impaired ability to recognize faces
Aphasia
Impairment of language.
- Associated with damage to the language dominant hemisphere.
- Nearly always involves damage to the left front-temporal and/or temporo-parietal regions.
Intraparenchymal Hemorrhage
Altercation in level of consciousness (~50%)
- Nausea and vomiting (~40-50%)
- Headache (~40%)
- Seizure (~6-7%)
