Presentation / Anatomy of Stroke Flashcards
What are symptoms if parietal lobe
Hemisensory loss Sensory inattention Apraxia Agnosia Tactile agnosia - decreased 2 point discrimination Inferior homonymous quadrantopia Gerstmann's
What is Gerstmann’s syndrome
Lesion in dominant parietal lobe R-L disorientation Finger agnosia Alcalculia (inability to do maths) Agrapghia Alexia (inability to understand words)
What are symptoms of occipital lobe lesion
Contralateral homonymous hemianopia
Cortical blindness
Visual agnosia
What are symptoms of temporal lobe lesion
Weirnecke’s aphasia/ dysphasia = same thin
Superior homonymous quadranopia / hemianopia on same side
Auditory agnosia
Amnesia
Prosopagnosia
What are symptoms of frontal lobe lesion
Hemparesis Broca's aphasia Executive dysfunction Personality change / disinhibition Memory loss Anosmia Agnosia
What are symptoms of cerebellar disorder
DANISH P Gait ataxia Inattention tremor Past pointing Dysdiokinesis Nystagmus - vertical
If hemisphere = peripheral e.g. finger nose ataxia
If vermis = gait ataxia
Lesion in medial thalamus / mammory bodies
Weirnecke’s encephalopathy
Korsakoff
Lesion in SN of basal ganglia
Parkinson’s
Lesion in striatum of basal ganglia
Huntington’s
Lesion in amygdala
Hypersexual
Hyperphagia
Visual agnosia
What does ACA supply
Frontal lobe
Motor / vision
What does lesion in ACA cause
Contralateral paralysis / hemiparesis LL > UL
Contralateral sensory loss
Gait impaiment
Impairment to logical thought and personality
What does MCA supply
Frontal, temporal and parietal lobe
Broca and Wiernecke’s
What can lesion in MCA cause
Contralateral hemiparesis - upper L worse than L
Contralateral sensory loss
Contralateral homonymous hemianopia
Gaze paralysis to side of stoke
Aphasia if dominant side - expressive or receptive
Unilateral neglect / ag
What do you get if on dominant side
APHASIA
What do you get if on non-dominant side
Neglect
Agnosia - can’t interpret sensation
What does lacunar / lentriculostrial artery supply
Basal ganglia
What can lesion here cause
Pure motor signs - isolated hemiparesis (internal capsule)
Pure sensory signs - isolated hemisensory (thalamus)
Mixed
Ataixa hemiparesis
Dysarthria - motor speech
What do basal ganglia lesions / lacunar not have
Cortical Sx
- Neglect / agnosia
- Dysphasia
- Cognition
- Visual field
What is a stroke RF for basal ganglia stroke
Hypertension
What does a basilar artery stroke affect and cause
Locked in syndrome as brain stem affected
What does PCA supply
Brain stem
Cerebellum
What does PCA stroke cause
Hemiparesis and sensory loss as tracts go through brain stem Quadraplegia Contralateral homonymous hemianopia Macular sparing Visual agnosia CN palsy Locked in Ataxia / vertigo / coma
What does retinal artery stroke cause
Sudden loss of vision
Amaurosis fugax
What does cerebellar stroke cause
Ataxia
Vertigo
Incoordination
Vertical nystagmus
`What is Weber syndrome
Branches of MCA or PCA that supply midbrain of brain stem
Midbrain infarction
Takes out SN / corticospinal / corticobulbar and 3rd CN tract
What do you get if Weber syndrome
Ipsilateral CN III palsy
Contralateral weakness of UL and LL
What is the posterior inferior cerebellar artery syndrome called if infarct
Lateral medullary / Wallenberg
What does it cause
Contralateral limb pain and temp loss - spinothalamic Ipsilateral face pain and temp loss - CN5 Ipsilateral Ataxia - CN8 Ipsilateral Nystagmus - CN8 Ipsilateral Vertigo - CN8 Vomiting Ipsilateral horners CN palsy 9/10 - Dysphagia - Dysarthria - Decreased gag reflex
What is the anterior inferior cerebellar artery syndrome called
Lateral pontine
What does it cause
Similar to Lateral medulla
BUT ipsilateral facial paralysis and deafness
How does haemorrhagic stroke present
Deceased GCS Headache N+V Seizure Stiff neck Photophobia
What is aphasia
Impairment of language affecting production or comprehension of speech and ability to read or write
What is receptive aphasia
Difficulty understanding spoken or written language
What is expressive aphasia
Partial loss of ability to produce language (spoken, manual or written)
What is Wernicke’s
Receptive aphasia
What causes Wernicke’s
Lesion in superior temporal gyrus of temporal lobe
What artery supplies
MCA
What does Wiernecke’s area do
Forms speech before sending it to Broca’s area
What does it result in
Sentences that make no sense
Word neologism + substitution
Still fluent but impaired comprehension
What is Broca’s
Expressive aphasia
What causes
Lesion in inferior frontal gyrus of frontal lobe
What artery supplies
MCA
What does it result in
Non-fluent speech
Laboured and haunting
Comprehension normal
What is a conduction stroke
Stroke affecting area between Wernicke’s and Broca - the arcuate fasiculus
What does it result in
Fluent speech
Poor repetition
Aware of error
Comprehension normal
What is a global aphasia stroke
Large lesion affecting all 3 ares
Severe expressive and receptive aphasia
TERMS
OK
What can cause cerebellar syndrome
PASTRIES Posterior tumour (cerebellar haemangioma) / lung cancer Alcohol MS Trauma Rare Inherited - Fredirech Epileptic meds - phenytoin Stroke
What is mnemonic to remember symptoms
DANISHP
- Dysdiodochokinesia - no rapid movement
- Ataxia
- Nystagmus - towards side of lesion
- Inattention tremur
- Scanning dysarthria / slurred staccato speech (jerky, explosive, slurred and loud due to ataxia of larynx)
- Hypotonia
- Past pointing
What does ataxia lead too
Wide based gait
Loss of heel toe
Instable
What is the nystagmus
Ipsilateral
Vertical if central cause
Horizontal if peripheral cause
N
Nystagmus
Ipislateral
See obtunded patient for normal functions
OK
What is dysarthria
Motor speech disorder
Unclear articulation
Logistics = normal
What is ataxia
Cerebellar lesion affecting coordination and balance
What is agnosia
Inability to interpret sensation or recognise things
Different types
Form of neglect
What are different types
Visual Sensory Prosopagnosia (can't recognise facE) Asteroagnosia (can't interpret by touch) Anasagnosia (denial of hemiplegia)
What is neglect
Deficit to awareness and attention to one side of field of vision
What is anosmia
Inabiity to smell
What is apraxia
Inability to carry out skilled motor tasks
What is ideomotor apraxia
Inability to know how or what to do with skilled motor tasks
What is agrpahia
Impairment of writing
What is alcalcui
Inability to do simple maths (parietal)
What is alexia
Inability to read or write
What causes unilateral signs cerebellar
MS
Vascular
SOL
What causes bilateral signs cerebellar
All unilateral
Inherited
Metabolic
Medication - phenytoin
