Presentation / Anatomy of Stroke Flashcards by Eilidh Seaton

What are symptoms if parietal lobe

Hemisensory loss 
Sensory inattention 
Apraxia
Agnosia 
Tactile agnosia - decreased 2 point discrimination
Inferior homonymous quadrantopia
Gerstmann's

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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)

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What are symptoms of occipital lobe lesion

Contralateral homonymous hemianopia
Cortical blindness
Visual agnosia

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What are symptoms of temporal lobe lesion

Weirnecke’s aphasia/ dysphasia = same thin
Superior homonymous quadranopia / hemianopia on same side
Auditory agnosia
Amnesia
Prosopagnosia

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What are symptoms of frontal lobe lesion

Hemparesis
Broca's aphasia
Executive dysfunction 
Personality change / disinhibition 
Memory loss 
Anosmia 
Agnosia

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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

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Lesion in medial thalamus / mammory bodies

Weirnecke’s encephalopathy

Korsakoff

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Lesion in SN of basal ganglia

Parkinson’s

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Lesion in striatum of basal ganglia

Huntington’s

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Lesion in amygdala

Hypersexual
Hyperphagia
Visual agnosia

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What does ACA supply

Frontal lobe

Motor / vision

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What does lesion in ACA cause

Contralateral paralysis / hemiparesis LL > UL
Contralateral sensory loss
Gait impaiment
Impairment to logical thought and personality

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What does MCA supply

Frontal, temporal and parietal lobe

Broca and Wiernecke’s

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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

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What do you get if on dominant side

APHASIA

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What do you get if on non-dominant side

Neglect

Agnosia - can’t interpret sensation

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What does lacunar / lentriculostrial artery supply

Basal ganglia

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What can lesion here cause

Pure motor signs - isolated hemiparesis (internal capsule)
Pure sensory signs - isolated hemisensory (thalamus)
Mixed
Ataixa hemiparesis
Dysarthria - motor speech

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What do basal ganglia lesions / lacunar not have

Cortical Sx

Neglect / agnosia
Dysphasia
Cognition
Visual field

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What is a stroke RF for basal ganglia stroke

Hypertension

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What does a basilar artery stroke affect and cause

Locked in syndrome as brain stem affected

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What does PCA supply

Brain stem

Cerebellum

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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

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What does retinal artery stroke cause

Sudden loss of vision

Amaurosis fugax

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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

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

Nystagmus | Ipislateral

See obtunded patient for normal functions

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