Stroke Flashcards
Sub-categorisation of Ischaemic strokes by aetiology
Atherosclerotic (in-situ)
* Large vessel
* Small vessel
Artery to artery embolism
* Extracranial vessel stenosis
* Dissection
Cardioembolic
Paroxysmal Embolism
Other
RFs Haemorrhagic stroke
- HTN
- Hypocholesterolemia
- Heavy EtOH use
- Cerebral amyloid angiopathy
- Antithrombotic therapy
- Underlying structural pathology
Where does ASA come off of
Vertebral arteries
Where does PICA come off of
Vertebral arteries
Order of cerebellar arteries (post/inf to sup/ ant)
PICA
AICA
SCA
Where does AICA come off of
Basilar artery
Anterior Cerebral artery syndrome
- Leg>Arm/Face
- Motor»_space;sensory
- Dysexecutive, abulia, urinary incontinence
- Dysphasia (dominant)
Posterior Cerebral Artery syndrome
- Homonymous Haemianopia
- Behavioural change, memory issues
Middle cerebral artery syndrome
- Face/Arm > Leg
- Dysphasia (dominant)
- Dyspraxia/Neglect (non-dominant)
- Homonymous Haemianopia
- Motor and Sensory
Basilar Artery/vertebral artery syndrome
- Locked in syndrome (sparing EOM)
- Initially vertigo, ataxia, diplopia, isolated limb symptoms
Small vessel/ lacunar stroke syndromes (5)
Gerstmann syndrome brain area
Inferior parietal lobule of dominant hemisphere
Angular and supramarginal gyri (Brodman area 39 and 40) near the temporal and parietal junction
Gerstman syndrome Sx
- Dysgraphia/agraphia
- Dyscalculia/acalculia
- Finger agnosia
- Left-right disorientation
- +/- aphasia
- +/- apraxia
Lateral Medullary syndrome synonyms
- Wallenberg Syndrome
- PICA syndrome
- Vertebral artery syndrome - misnomer really as can cause other issues
Lateral Medullary syndrome Sx
Contralateral
* trunk/limb numbness (pain/temp)
Ipsilateral
* Facial numbness (pain/temp)
* Skew deviation/room tilt
* Dysphagia/hoarseness/gag
* Horner’s syndrome
* Limb ataxia
- Palatal myoclonus
- Vertigo/nystagmus
Top of the Basilar Syndrome
- Ptosis
- Dilated pupils
- Ocular motor deficits
- Somnolence (thalamic infarction), hallucinations, dreamlike behaviour
- Motor function otherwise preserved
Can cause full basilar thrombosis -> locked in
Balint syndrome
- B/L parietal/occipital junction lesions e.g. watershed
- Simultagnosia
- Oculomotor apraxia
- Optic ataxia
Anton syndrome
- Bilateral occipital lesions
- Cortical blindness
Benedikt syndrome,
Webber syndrome
- Midbrain stroke
- Posterior cerebral artery or penetrating branches of basilar artery
- CN III palsy
- Ataxia/choreoathetosis
Webber syndrome
* Similar to Benedikt except more hemiplegia than limb ataxia
Anterior spinal artery syndrome
- Loss of power distally
- +/- Loss of temp/pain
- Posterior column unaffected
Spinal cord syndrome with syringomyelia
Central cord syndrome
Location of haemorrhage in cerebral amyloid angiopathy
Lobar Haemorrhage
Location of haemorrhages in deep haemorrhages
B: Basal Ganglia
C: Thalamus
D: Pons
E: Cerebellum
(A is a lobar haemorrhage)
Main RF for lobar cerebral haemorrhage
Cerebral amyloid angiopathy
