Stroke

Question 1

Most common lesion sites.

Answer 1

• origin to common carotid
• main bifurcation of the MCA
• junction of vertebral arteries with the basilar artery

Question 2

MCA Strokes

Answer 2

• most common
  Sx:
• CL hemiplegia (mostly UE) and loss of sensation primarily in the arm and face
• homonymous hemianopsia (common)
• if in L hemisphere: possible aphasia and apraxia
• if at main stem of MCA: possible global aphasia

Question 3

ACA Stroke

Answer 3

• rarely involved
  Sx:
• CL hemiplegia / sensory loss (LE more freq)
• if extensive damage on dominant side: possible mental confusion, aphasia, CL neglect

Question 4

PCA Stroke

Answer 4

Sx:

• persistant pain syndrome OR CL pain/temp loss
• homonymous hemianopsia, aphasia, thalamic pain syndrome

Question 5

Vertebral-basilar Stroke

Answer 5

• often results in death from associated edema
  Sx:
• if pons affected: quadriparesis and bulbar palsy (“locked-in” syndrome) –> communication by eye blinking
• other: vertigo, coma, diplopia, nausea, dysphagia, ataxia

Question 6

AICA Stroke (anterior inferior Cb)

Answer 6

Sx:

• unilat deafness
• CL loss of pain/temp
• paresis of lateral gaze
• unilat Horner’s syndrome (ptosis, constricted pupil, loss of sweating)
• ataxia
• vertigo
• nystagmus

*think Hornet! small eyes, no sweating

Question 7

SCA Stroke (superior Cb)

Answer 7

Sx:

- severe ataxia, dysarthria, dysmetria, CL pain/temp loss

Question 8

PICA Stroke (posterior inferior Cb)

Answer 8

Sx:

• Wallenberg’s syndrome (vertigo, nausea, hoarseness, dysphagia, ptosis, decreased impairment of sensation in ipsilateral face and CL torso/limbs)
• possible: Horner’s syndrome

*Think of: Wallie! dizzy, can’t speak, no sensation

Question 9

Stages of Recovery

Answer 9

1: flaccid, no limb mvmt
2: synergies, begining spasticity, min voluntary mvmt
3: spasticity, voluntary control of synergies begins
4: indepenedent voluntary mvmt, spasticity declines
5: if pt progresses: synergies fading
6: no spasticity, normal-ish coord/mvmt