Stroke Flashcards
Ninja Nerd
The middle cerebral artery supplies what are of the cerebral cortex( In terms of primary motor function)
The part that contros the Face and arms
The anterior cerebral artery supplies what are of the cerebral cortex( In terms of primary motor function)
The part that controls the leg
Which blood vessels supply the anterior part of the brain?
Anterior cerebral artery
Internal carotid
Middle cerebral artery
Which blood vessels supply the posterior part of the brain?
Posterior cerebral artery
Basillar artery
Vetebral artery
Which parts of the brain does the posterior artery supply?
The occipital lobe
Thelamus
Mid brain
Parts of temporal
Which parts of the brain does the basillar artery supply?
Pons
Superior anterior nd inferior part of the cerebellum
Which parts of the brain does the vertebral artery supply?
Medulla and
Posterior and inferior aspects of the cerebellum
Whats the difference between trans ischemic stroke and acute ischemic stroke
TIS:Neural defesite without evidence of infarction bt CT or MRI & lasts less than 24hrs
Causes ot TIS
Hypoxic(Cardiac arrest, shock ( speric or cardiogenic), respiratory failure)
- Thrombotic
Due to plaque
Hypertension
Diabetes
Smoking
Obesity
Dyslipedemia
- Embotic
atrial fibrillation,
Left ventricular aneurysm
Mechanical heart valve
Paradoxical embolism ( DVT & patent FORAMRN OVALE)
Intra cerebral hemorrhage causes
Intra cerebral hemorrhage can be classified into? What are the difference
Hypertension
Coagulopathy
Malignancy
Trauma
Hypertension intra cerebral hemorrhage usually occur at
Bassl ganglia
Pons
Cerebellum
Sub arachnoid hemorrhage usually occur due to?
Poped aneurysm
What is the most common type of aneurysm that will rupture?
Berry/Saccular aneurysm
Intra cerebral hemorrhage causes accumulation of blood in?
The parenchyma of the brain
Rupture in the ACA causes what neuro deposit
Contralateral weakness of the lower limb than the upper limb& face
Contralateral lose of sensation in the lower limb than face and upper limbs
- Prefrontal cortex deficit
Bullia: decrease motivation and desire to participate in certain activities
Akinetic mutism: is a medical condition where patients tend neither to move nor speak.
Rupture in the MCA causes what neuro deposit
Contralatera motorl weakness of the face and upper limb more than lower limb
Contralateral sensory weakness of the face and upper limb more than lower limb
Difficulty with skilled movements even when a person has the ability and desire to do them.
- Frontal eye field
If the left side MCA is clotted it will cause gaze deviation to that same side ( ipsilateral gaze deviation) - Brocas area (@ Left side hemisphere of Parietal)
Brocas aphasia - Warinke (@ Left hemisphere of temporal)
Werinke aphasia - Temporal & parietal lobe( is the ath optic N follow)
Damage to the optic radiation causing contral lateral loss in the visual field. homonymous hemianopia, is a visual field loss in the same halves of the visual field of each eye. For example, in right HH, the visual field loss is on the right side in the right eye and on the right side in the left eye
Note: In an ICA occlusion you might have symptoms of both MCA & ACA because ICA is the main branch that later forms the two
Whats the special feature of ICA occlusion that will que. Other than the MCA and ACA features that will present
Opthlamic nerve damage ( causing temporary Mono occular vision loss amaurosis fugax
Whats watershed syndrome & what can cause it?
Hypovolumia
A watershed strokeoccurs when the blood flow to parts of the brain, known as border zones, is severely reduced, leading to brain tissue death. The border zones are vulnerable because they are situated furthest away from the three major arteries that service the brain.
What are the conditions that can occur in MCA/ACA watershed zone damage?
Proximal upper and lower thrunk loss of sensation
Man in a barrel syndrome isa neurological syndrome involving bilateral upper extremity weakness with preserved facial and lower extremity strength.
What are the conditions that can occur in MCA/PCA watershed zone damage?
Prosopagnosia also known as face blindness, is a cognitive disorder of face perception in which the ability to recognize familiar faces, including one’s own face, is impaired, while other aspects of visual processing and intellectual functioning remain intact
Rupture in the PCA causes what neuro deposit
- visual field
Contralateral visual loss ( contralateral homonus Heminopia)
Inability to read Alsxia without agraphia - Thalamus
Contralateral loss of sensation and pain - Mid brain
Benedict syndrome: Benedikt syndrome (paramedian midbrain syndrome) is characterised by varying levels of ipsilateral third cranial nerve palsy, hemiparesis, and contralateral tremor.
Webber syndrome:
Claude’s syndrome
Lacuna infarcts are a subset of MCA occlusion (it involves sma branches from the MCA)
The Lacuna infarction can cause?
- Contralateral
Pure motor
Pure sensory
Sensor motor
Ataxiis hemipheisis
Disathrial clumsy hand syndrome
Rupture in the Basilar causes what neuro deposit
Ippsilateral 6th N palsy (Abducent N)
Corticospinal tract ( contro lateral weakness)
Medial meniscus ( contro lateral loss of touch and vibration
The basilar artery give off what major artery?
AICA
Superior C Artery
Damage to the AICA can cause?
5th (weakness in mastication muscles on the same side) & 7th N palsy ( facial weakness on the same side)
- Cochlear N damage (Deafness)
Vestibular N( nausea, vomiting, loss of balance) - Trigeminal tract damage
- Defending Sympathetic tracts ( Anhydrousis, miosis, ptosis)
Superior CA
Ataxia
Dysmetria
Damage to the vertebral can cause?
The tongue deviates to the same side ( hypoglosial N)
Contralateral muscle weakness ( corticospinal)
Contralateral sensory loss
Features of ICH & SAH
ICH
Headache
Increase ICP
SAH
Thunderclap headaches
Meningitis signs
Increased ICP
The gold standard to check for the location of sub arachnoid hemorrhage is
Digital subtraction angiogram
In transient ischemic attack how do you managed it using risk calculation
A- >60 year old
B- >140/90
C- >clinical features (Aphasia= 1, any other defisite= +2
D- >60 = +2, <60 min = +1
DM- >+1
Treatment of AIS?
TPA : For <3 hrs of normal activity
Thromdectomy >6 hr of normal activities
An IV injection of recombinant tissue plasminogen activator (TPA) is the gold standard treatment for ischemic stroke.
Its primary function includescatalyzing the conversion ofplasminogento plasmin, the primary enzyme involved in dissolving blood clots.
VIDEO
Note: in a patient with worsening clinical features of stroke per hr it should be directly considered a Acute Ischemic Attack/Stroke even if the brain scan is looking normal
How do you manage a TIA?
Dual anti platelets therapy DAPT
Aspirin & Clopidogrel
Clopidogrel isan antiplatelet medicine. It prevents platelets (a type of blood cell) from sticking together and forming a dangerous blood clot
If atrial defeibulation is present + then add
Noble oral anti coagulant
In managing a stroke pt. In emergency you do?
A
B
C
Glucose = too high = swelling in the brain, too low = neurons won’t be able to handle the stress
NICE Head
A right hand man with a dominant side parietal lobe ischemia will cause?
Mathematics defisites/ Acalculia
Understanding written text defisites/ Agraphia
Loss of L& R orientation/ Finger agnosia
Speech imparement
Damage to the dominant parietal lobe causes a syndrome called?
Gerstmann syndrome
What are the features of Gerstmann syndrome
Acalculia
Agraphia
L&R disorientation/ Finger Agnosia
Speech imparement
A right hand man with a non dominant side parietal lobe ischemia will cause?
Visual spacial skill loss/ Constructional Apraxia
Hemi Neglect
Anoso Agnosia/ inability to appreciate severity ( 😊 ungrateful fuck)
Clock face test is done to confirm?
Constructional Apraxia
If someone is eating from a plate and only eats one side without touching the other it’s a sign of?
Or shaving only one side of your face
Hemi neglect
Temporal lobe ischemia will affect?
Hippocampus/ short term memory/Antegrade Amnesia
Can’t remember faces/ Prosoagnodia( damaged at the junction btw temporal and occipital lobe)
Complex Hallucinations
Deja Vu/ undue familiarity
Jamai Vu/ u familiarity
Long term memory is stored at?
Neo cortex
Pure word deafness is a sign of damage to?
Sup. Temporal gyrus (warinke)
Pure word blindness is a sign of damage to?
Left occipital lobe or Splenium
Frontal lobe ischemia will affect?
Change in personality
Anti social behavior
Uncontrolled urination
Apathy
Abulia lack of desire to speak
Primitive reflexes ( e.g grasp reflexes, Rooting reflexes, Note: Moro Reflexes never reappear no matter what)
Loss of Programmed gaite( Magnetic Gait or gait Apraxia)
Which part of the brain control urination
Paracietal lobule
Constructional Apraxia and gait Apraxia is as a result of damage to what vessel & affects what part of the brain?
Constructional = Dominant parietal lobe & MCA
Gait = frontal lobe & ACA
Occipital lobe ischemia will affect?
PCA damage
Visual Hallucinations
Palinopsia: persistent of images even when the image has been removed
Asimultagnosia: : can’t identify two objects at the same time
Homonymus heminopia
Gun barrel vision
What’s cortical blindness?
What’s anton syndrome & which blood vessels is damage to cause it?
Anton Syndrome isa manifestation of bilateral occipital lobe damage in cortically blind patients. These patients lack insight into their disease and deny their blindness.
Bilateral distal PCA
Damage to what blood vessels can cause paraplegia
ACA
Brocas area is supplied by?
Sup. Division of MCA
LMCA Lesions can result in
DMCA “” “” “”
LMCA = APHAsIA
DMCA = APRAXIA
Lacunar stroke can occur due to?
Athtosclerosis/**Lipohyalinosis of smaller blood vessels
Berry aneurysm location & rupture is common @
Anterior communicating Artery
Between A1 and A2 circulation in the circle of lewis which is tolerable to ischemia due to collateral flow & which isn’t?
A1 is tolerable
& A2 isn’t
The basilar artery gives off the posterior cerebellar artery which he a P1 & P2 section
The P1 section supplies & the P2 section supplies?
Vertebral artery lesions causes
Pontine stroke can be caused by lesion to what artery?
And the lesions will cause?
P1= mid brain ( mid brain stroke)
P2= occipital cortex ( visual hallucinations) /
Medullary stroke.
Basilar artery
What is the nerve that can be compressed in an un ruptured or rupturedPst communication artery Berry aneurysm
3rd cranial N causing (ptosis, squint)
Which blood vessels is affected in mrdial medullary syndrome
Anterior spinal artery
Which blood vessels is affected in lateral medullary syndrome
Vertebral artery or Posterior inferior cerebellar artery
Which nerves are Functions are impaired in collusion to Post. Inferior cerebellar artery PICA
5,7,8,9,10,11
Which nerves are Functions are impaired in collusion to Ant. Spinal artery
12th N
Which nerves are Functions are impaired in collusion to Ant. Inferior cerebellar artery AICA
7,8
What’s Horner syndrome
Blockage to which blood vessels can cause Horner syndrome
Horner syndrome?
Introduction. Horner syndrome is a rare condition classically presenting with partial ptosis (drooping or falling of upper eyelid), miosis (constricted pupil), and facial anhidrosis (loss of sweating) due to a disruption in the sympathetic nerve supply.
PICA and Superior Cerebellar Artery
Which cerebral artery doesn’t participate in the circle of Willis?
MCA
What’s Total anterior circulation stroke
The blood vessels involved and its features
ACA+MCA
Unilateral weakness (and/or sensory deficit) of the face, arm and leg.
High Cerebral malfunction
Homonymous hemianopia
Which cranial nerve has a crossed origin?
CN4
Muscle of the right eye is supplied by the left and vise visa
Which N is the longest?
Vagus N
Which nerve has the longest intra cranial route?
Trochlear N
Which cranial nerve has a dorsal origin?
Note all other originte from ventral root
Trochlear N
Which nerve is the thickest and the thinnest
Thickest= Trigeminal N
Thinnest= 4th N
Substanria Niagara lesion=
Parkinson’s dxs
