Stroke Flashcards
1
Q
MCA stroke.
A
- occurs in motor and sensory cortices effecting face and upper limb, also wernike and broca areas
- Contralateral paralysis and sensory loss on face and upper limbs
- aphasia if left (dominant) hemisphere
- Hemineglect if non dominant usually right hemisphere
2
Q
ACA stroke
A
- Motor and sensory cortices of lower extremity
- Contralateral paralysis and sensory loss
- lower limb and urinary incontinence
3
Q
Lenticuolostriate artery stroke
A
- Striatum and internal capsule
- Contralateral paralysis, absence of cortical signs such as aphasia neglect or visual changes
- PURE motor stroke commonly caused by hyaline arte3riosclerosis secondary to uncontrolled htn
4
Q
Anterior spinal artery stroke
A
- Corticospinal tract, Medial lemniscus and Caudal medulla (CN XII)
- Contralateral paralysis of upper and lower limbs
- Decreased contralateral proprioception
- Ipsilateral hypoglossal dysfunction → tongue deviates ipsilateral
- Medial Medullary syndrome caused by infarct of paramedian banches of ASA or vertebral arteries
5
Q
PICA stroke
A
- Lateral medulla → nucleus ammbiguus ( CN 9, 10, 11)
- Dysphagia, hoarsness and decreased gag reflex are big symptoms
- Vestibiular nuclei
- Vomit, vertigo, nystagmus
- Lateral spinothalamic tract and spinal trigeminal nucleus
- decreased pain and temp sensation from contralateral body and ipsilateral face
- sympathetic fibers
- ipsilateral horner syndrome
- Inferior cerebellar peduncle
- ipsilateral ataxia and dysmetria
6
Q
AICA stroke
A
- Facial nucleus
- paralysis of face (LMN vs UMN lesion seen in cortical strokes), decreased lacrimation salivation and taste
-
Vestibular nuclei
- Vomit vertigo and nystagmus
-
Spinothalamic tract and spinal trigeminal nucleus
- Dec pain and temp ssensation from contralageral body and ipsilateral face
-
Sympathetic fibers
- horners syndrome ipsilateral
-
Middle and inferior cerebellar peduncles
- ipsilateral ataxia dysmetria
- Labryinthine artery
- ipsilateral sensorineual deafness and vertigo
Italics are same sx as PICA
7
Q
What is lateral medullary syndrome (Wallenberg)
A
- Nucleus ambiguus symptoms specific to a PICA infarction
-
don’t PICA horse that can’t eat
- hoarsness and dysphagia
8
Q
What is Lateral pontine syndrome?
A
- Facial nucleus effects specific to AICA lesion
- Facial droop means AICA’s pooped
9
Q
Basilar artery stroke
A
- Pons medulla and lower midbrain
- if RAS is spared consciousness is preserved
- If not Locked in syndrome
- Corticospinal and corticobulbar tracts
- Quadriplegia, loss of voluntary facial, mouth, and tongue movement
- Ocular cranial nerve nuclei, paramedian pontine reticular formation
- Loss of horizontal but NOT vertical eye movement
10
Q
Occipital lobe stroke
A
Contralateral hemianopia with macuolar sparing
alexia without agraphia
11
Q
Brown Sequard Syndrome
A
- Ipsilateral loss sensation at level of lesion
- Ipsilateral LMN signs at level of lesion
- Ipsilateral UMN signs below lesion
- Ipsilateral loss proprioception vibration and light touch and tactile sense below lesion
- Contralateral loss of pain temp and crude touch below lesion
12
Q
Marcus Gunn Pupil
A
- light is swung to affected eye both puppils dilate instead of constrict due to imparied conduction of light signals along injured optic nerve
- assoc. with optic neuritis and early MS
13
Q
- Craniosacral Outflow PSNS:
- CN III Edinger Westphal nucleus- does ___ & ____.
- CN VII Superior salivary nucleus does _____
- CN IX Inferior salivatory nucleus does _____
- CN X dorsal vagal nucleus does _____.
A
- Edinger Westphal does miosis and accomidation
- Superior salivary does salivation in lacrimal gland
- Inferior salivary does salivation in parotid gland
- Dorsal vagal does GI and lung secretions
14
Q
M1 M4 and M5 location and agonist action?
A
- CNS
- Procognitive agonist action
15
Q
M2 location and agonist action and antagonist::?
A
- Heart
- Bradycarida agonist
- Tachycardia and increased AV node conduction antagonist
16
Q
M3 location (5 of them) agonist and antagonist?
A
- Urinary tract, Bladder contraction, bladder relaxation with antagonist
- GI tract, increase peristalsis, decrease peristalsis antagonists
- Exocrine glands, increase secretion, decrease secretion antagonist
- eye, miosis, mydriasis antagonist
- Airway, bronchoconstriction, bronchodilation antagonist
- Muscarinic agonist=cholinergic= anti sympathetic*
- Muscarinic antagonist=anticholinergic=sympathetic*
17
Q
Posterior columns function?
A
Fine touch proprioception (discriminative touch)
18
Q
What are the three synapses of the posterior column?
A
- Sensory neuron → dorsal column nuclei (in medulla)
- DCN decusates at medial lemniscus and synapses at thalamus
- Thalamus → primary sensory cortex
-
PC “poliltically correct” → SDTP “some doctors think politically”
- Sensory neuron → Dorsal column → Thalamus → Primary sensory cortex
19
Q
Corticospinal tract function?
A
- controls movement, UMN
20
Q
Corticospinal tract synapses?
A
- Primary motor cortex → internal capsule → UMN → medullary pyramid
- at medullary pyramid it splits into anterior and lateral corticospinal tract
- then they descend down into the anterior horns of the spinal cord to control movement
- “PPLM” Primary motor, medullary Pyramids, Lcst, Movement
- “Prickly Plants Lack Moisture”
- cactus are spiney and live in deserts
21
Q
Lateral spinothalamic tract function
A
Pain and temp sensation but two to three segements below on the contralateral side
Lissauer’s tract
22
Q
What is Lissauer’s tract?
A
- Part of the lateral spinothalamic tract that carries pain and temp sensation up two to three segments before they cross back over
- injury to C5 on right Spinothalamic tract you experience pain temp loss at C7 pain temp loss on the left
23
Q
Brown Sequard syndrome? Injury at Right T8
A
- Hemi transcection of spinal cord knocking out posterior columns, corticospinal tract, and lateral spinothalamic tract
- Ipsilateral loss of fine touch and proprioception (PC) from T8 down
- Ipsilateral UMN symptoms below T8
- LST Starting at T10 and down on contralateral side loss of pain and temp
