Stroke Flashcards
ACA stroke
Motor or sensory loss
Predominantly legs
MCA stroke
Aphasia
Apraxia
Anosmia
Motor or sensory loss more in arm than leg
PCA stroke
Motor: CN palsy, Hemiplegia
Sensory: hemi loss
Vision: homonymous hemianopia, issues with conjugate gaze
SCA stroke
Motor: ataxia
Basilar artery stroke
Coma
Motor: quadriparesis
PICA stroke
Wallenberg syndrome
Horners
CN 9, 10 palsy
Sensory loss
Lacunar stroke
Pure motor stroke from infarct of internal capsule
5 main types of stroke
Cardio embolic Large Artery Small vessel Other Unknown
Cardio embolic stroke
History: atrial fibrillation, cardiomyopathy, ,I, endocarditis, mechanical heart valve
IX: multiple territory lesions from huge clots
Tx: warfarin, NOACs
Large artery stroke
IX: scattered single territory lesions,
CTA: stenosis
Tx:
Carotids can have stent or end arterectomy if symptomatic and greater than 50% stenosis
Intracranial: statins and dual anti platelet agent
Small vessel stroke
Hx: non white
IX: lesion in territory of small perforating arteries
To: BP lowering prevents hemorrhage later
Single anti platelet agent
Statins are controversial
Other kinds of stroke
Causes:
Moyà Moyà disease
Cervical dissection
Arteriopathy
Transient ischemic attack
Transient episode of neurological dysfunction resulting from ischemia but without acute infarction
SX: high risk: unilateral motor weakness, speech deficit lasting more than 5 minutes, occurring in last 48h
IX: diffusion weighted MRI, CTA, carotid us, ECG, CBC
Rule out transient neurological attacks (migraine, seizure, vertigo)
Tax: if carotid stenosis: antiplatelets and revascularization, intracranial may use tpa
Sub-arachnoid hemorrhage
Ex: trauma, aneurysm SX: thunderclap headache Stiff neck Nausea/vomit CN palsy (Beware sentinel headache) IX: CT head if 6h Tx: clip/coil aneurysm, quit smoking, lower BP
Cerebral venous thrombosis
Ex: OCP, genetic, infection, iron deficiency
SX: new seizure, headache progressive, focal neurological findings
IX: CT venogram
Tx: anticoagulate, treat cause, surgical intervention if fulminant
Intercerebral hemorrhage
Ex: HTN”drugs, amyloid angiopathy, AVM
SX: seizure
IX: CTA, MRI- measure volume
Tx: blood pressure
If a stroke is in the frontal eye fields, which way do the eyes deviate?
Towards the stroke (away from paralysis)
Conduction aphasia localized to
Arcuate fasiculus
How to treat cerebral edema in stroke?
Peaks at 24-96h
SX: drowsiness, pupillary asymmetry, periodic breathing patterns
Tx: hyperventilation, mannitol, furosemide
Webers Syndrome
Ex: infarction in penetrating vessels of PCA
Path: damages cerebral peduncle, fasicle of CN 3, pyramidal fibers
Difference between RAPD and blown pupil
RAPD is CN2 issue- decreased response when light shines on affected pupil
Blown pupil- cN3 issue- no response to stimulation
