Stroke Flashcards
Multiple TIA dvla advice
Inform dvla
Not driving for 3 months
Stroke or 1 TIa dvla
Doesn’t need to be informed
Stop driving for a month
Dvla narcolepsy
Stop driving until satisfied control of sx
Craniotomy dvla
1 year off driving
TIa rx intolerant of clopidogrel
Aspirin + dipyridamole lifelong
Thrombolysis window
4.5 hrs
Weber’s syndrome
Locations
Artery
SX
Location: Midbrain
Artery: PCA
SX:
1. CN III palsy (eyes get caught in a web)
2. Contralateral weakness of upper and lower extremity
Medial pontine syndrome
-Art
-sx
- paramedian branches of the basilar artery.
- corticospinal tract: contralat. hemiplegia
- Medial lemniscus: contralateral loss of proprioception & vibration
- middle cerebellar peduncle: ipsilateral ataxia
- facial nerve (CN VII): ipsilateral facial weakness
- abducens nerve (CN VI) nucleus: lateral gaze paralysis and diplopia (affected eye looks down and towards the nose)
BASILAR (branch’s of the base = face )
Lateral Pontine Syndrome
- Art
-Sx 4
AICA (Pons)
1. Contralat. loss P&T (spinothalamic tract)
2. Ipsilat ataxia arm and leg (spinocerebellar tract)
3. ipsilateral Horner’s
(sympathetic pathway)
4. Ipsilateral face loss P&T (sensory nucleus of trigeminal nerve)
“facial droop means AICA is pooped”
similar to Wallenberg’s, but:
Ipsilateral: facial paralysis and deafness
‘Locked-in’ syndrome
Location
Sx
- Basilar artery
Pons, cerebellum
Quadriplegia
Anarthria
Restricted horizontal eye movement
CN Medial Medullary Syndrome
CN12 is the only midline CN
deviation of the hypoglossal nerve to the ipsilateral side (side of the infarction)
“lick your wounds”
CN lateral pontine syndrome
cranial nerves 5, 7, and 8 *
loss of function of cranial nerve 7 (facial nerve) = facial paralysis
“facial droop means AICA is pooped”
CN Medial Medullary Syndrome
CN12 is the only midline CN
deviation of the hypoglossal nerve to the ipsilateral side (side of the infarction)
“lick your wounds”
CN of Lateral Medullary Syndrome
CN 9, 10, and 11
Mainly 9glossopharyngeal, hoarseness
CN 10 vagus nerve= dysphagia
“Never pick a (PICA) horse (hoarseness) that cannot eat (dysphagia)
CN lateral pontine syndrome
cranial nerves 5, 7, and 8 *
loss of function of cranial nerve 7 (facial nerve) = facial paralysis
“facial droop means AICA is pooped”
CN Medial Medullary Syndrome
CN12 is the only midline CN
deviation of the hypoglossal nerve to the ipsilateral side (side of the infarction)
“lick your wounds”
Rule of 4 localize brainstem vascular syndromes
First Rule: 4 midline structures that begin with the letter M
Second Rule: 4 lateral structures that begin with the letter S
Third Rule: 4 CN below the pons, 4 in the pons, and 4 above the pons
Fourth Rule: There are 4 midline CN motor nuclei
Within each of the 4 rules are 4 additional guidelines necessary to understand in order to localize the site of vascular occlusion [13].
Medulla: CN 9–12,
9= glossopharyngeal, 10= vagus, 11= spinal accessory, 12= hypoglossal
Pons: trigeminal, abducens, facial, vestibulocochlear (CN 5–8, respectively)
Midbrain: oculomotor, trochlear (CN 3–4, respectively)
Fourth rule: There are 4 midline motor nuclei: The nuclei of cranial nerves 3, 4, 6, and 12:
Location of stroke
Medial medullary syndrome
Contralat weakness & loss Vibrations & Proprioception
INO
Divation of tongue to site of lesion
Lateral medullary/ Wallenberg
Pica
IPs. Facial loss of P&T, horners, hoarseness dysphasia
N/v vertigo nystagmus
Medial medullary
IPs Hypglossal nerve
Contralat. Hemiplegia
Contralat loss of v&p
Pat. Pontine
Aica
ISP. Facial paralysis horners, sensory hearing neuro loss, loss of P&T face,
Contralat P&T loss
MCA non dominant
Hemineglect
MAC dominant
Broca aphasia
