Stroke Flashcards
Regions middle cerebral artery supplies
Lateral side of frontal, parietal, and temporal lobes
What symptoms occur with Middle cerebral artery occlusion?
- Weakness and sensory deficits in the opposite side
- Face and arms more affected than legs
- Homonymous hemianopsia w/ipsilateral gaze deviation (“looking at their lession”)
What happens with middle cerebral artery occlusion on the side of the dominant cerebral hemisphere?
Aphasia or problems speaking
What happens with middle cerebral artery occlusion on the side of the nondominant cerebral hemisphere?
Contralateral hemineglect
Regions anterior cerebral artery supplies
Anterior and medial aspects of the frontal, parietal, and temporal lobes
Anterior cerebral artery occlusion symptoms
- Weakness and sensory deficits on the opposite side
- More likely to affect the legs
- Associated with frontal lobe problems (personality changes)
Regions lenticulostriate arteries supply
Deep structures of the brain
Lenticulostriate (lacunar stroke) symptoms
-Lack of cortical signs (no aphasia, neglect, or visual field cuts)
Pure motor lenticulostriate stroke symptoms and location
Posterior limb of the internal capsule.
Hemiparesis of legs, arms, and face on one side (disrupion in the corticospinal an corticobulbar tracts)
Pure sensory lenticulostriate stroke symptoms and location
Lateral thalamus. Numness in legs, arms, face of contralateral side of the body
Vertebral artery supply
Inferior cerebellum and lateral medulla
Cerebellar infarct symptoms
-Cerebellar dysfunction (ataxia, vertigo, blurred vision, nystagmus, vomiting, postural instability)
Lateral medullary infarct (Wallenburg syndrome) symptoms
-“Crossed symptoms” Numbness on one side of fase and opposite side of body due to ipsilateral cranial nerve damage and damge to sensory fibers where they cross on the contralateral side.
Basilar artery supply
Rostral brainstem and occipital lobes
Basilar artery stroke symptoms
CN palsies. Can causes gaze issues, hemianopsia, miosis. More extensive occlusions can cause damage to the reticular activating system–can cause altered level of consciousness and damage to other CN
What is unique about basilar artery stroke?
One of the few types of stroke that can cause loss of consciousness
Posterior cerebral supply
Occipital lobes
Symptoms of posterior cerebral stroke
Homonymous hemianopsia of contralateral vision field. Often have macular sparing and may struggle naming colors. Nondominant hemisphere infarct can result in neglect of affected vision field.
Intracerebral hemorrhage
- Hypertension
- Usually in deep structures of the brain
- Less common in cerebral cortex
Subarachnoid hemorrhage
“Worse headache of my life” or thunderclap headache. Often have nausea, nuchal rigidity, photophobia, alterled level of consciousness, vomiting. May have VIth nerve palsy or IIIrd nerve palsy from intracranial pressure.
Most common cause of subarachnoid hemorrhage?
Trauma
Most common non-traumatic cause of subarachnoid hemorrhage?
Berry aneurysm
Ischemic stroke
Can be from thrombosis or embolism.
Inadequate oxygen delivery occurs. Neuronal cell death begins within 4 minutes. Sudden onset focal neurological deficits (usually without headache).
First thing to do when stroke suspected?
Non-contrast head CT.
What is CT ideal for identifying
Hemorrhagic stroke.
What is the most sensitive test for ischemic stroke?
MRI
When is cerebral angiography indicated?
To evaluate patients w/ischemic strokes in verebrobasilar distribution and patients with subarachnoid or intraparenchymal hemorrhages.
Nonmodifiable risk factors
Age, race, ethnicity, hereditary
Modifiable risk factors
Hypertension, DM, lipids, atrial fibrillation management, smoking.
TPA mechanism of action
Enhances conversion of plasminogen to plasmin by binding to fibrin. Initiates fibrinolysis
What does TPA do after stroke?
Helps restore patency to the thrombosed vessels
When does TPA have to be administered by?
Within 3-4 1/2 hours of onset.
