Stroke Flashcards
Circle of Willis Arteries
a. anterior cerebral artery
b. internal carotid artery
c. posterior communicating artery
d. posterior cerebral artery
e. basilar artery
f. middle cerebral artery
g. anterior communicating artery (minute connection between the left and right anterior cerebral arteries)
Middle cerebral artery
- Most common for stroke b/c connected to artery of the heart - supplies a lot of areas!
- Supplies almost the entire lateral surface of the frontal, parietal, and temporal lobes as well as white matter and basal ganglia
- Largest of the terminal branches of the internal carotid and the direct continuation of this vessel
- Lateral convexity of Hemisphere; Broca’s, Wernicke’s speech areas, face, arm
Left hemisphere
Contralateral hemiplegia (primary motor area)
Contralateral hemiparesthesia (primary sensory area)
Aphasia (Broca’s, Wernicke’s or combination or connections)
Cognitive (frontal lobe, prefrontal)
Affective (emotional labiliity and depression)
Right Hemisphere:
Contralateral hemplegia
Contralateral hemiparesthesia
Perceptual deficits (posterior multimodal association area) (left sided neglect)
Apraxia (anterior multimodal association area, premotor area and/or primary motor cortex
Cognitive
Affective (euphoria or lack of awareness)
Anterior cerebral artery
- Superior, lateral, and medial aspects of frontal and parietal lobes
- Basal ganglia, corpus callosum
- ACA: Leg, feet
Lesion: Contralateral hemiplegia Contralateral hemiparesthesia Cognitive Apraxia Affective (same as MCA)
Posterior Cerebral Artery
- Medial and inferior surfaces of temporal and occipital lobes
- Thalamus, hypothalamus (however not usually affected by lesion in this area)
Lesion
Memory loss
Visual Perceptual Deficits (occipital lobe and posterior multimodal association area)
Visual Field Cuts (optic chiasm)
Brainstem and Cerebellar Arteries
- Superior or anterior inferior cerebellar
- May also affect medulla
- Posterior Inferior cerebellar
- Basilar
- Vertebral
Brainstem and Cerebellar Arteries:
Superior or anterior inferior cerebellar
Ipsilateral ataxia Ipsilateral hypotonicity and hyporeflexia Dysmetria Adiadochokinesia Movement decomposition Asthenia Rebound phenomenon Staccato voice Ataxic gait Intention tremors Incoordination
Brainstem and Cerebellar Arteries
-May also affect medulla
Vestibular signs (nystagmus, vertigo nausea) Facial Sensory Impairment Dysphagia Dysarthria Bell’s palsy
Brainstem and Cerebellar Arteries:
-Posterior Inferior cerebellar
- Ipsilateral hypertonicity and hypoeractive reflexes (posterior and anterior spinocerebellar tracts
- Vertigo, nausea, nystagmus (vestibular nuclei junction pons and medulla)
- Supplies lateral medulla and back/ undersurface of brain
Brainstem and Cerebellar Arteries:
-Basilar
- Formed by the vertebral arteries joining at the medulla/pons level
- Pons, corticospinal tracts, abducens, trigeminal, and facial nerve nuclei
- Contralateral hemiplegia (corticospinal)
- Medial or internal strabismus (abducens)
- Ipsilateral sensory loss of the face (trigeminal)
- Loss of the masseter reflex and the corneal reflex (trigeminal)
- Bells’ Paly and Hyperacusis (facial)
Brainstem and Cerebellar Arteries:
-Vertebral
Dysphagia (accessory)
Anterior Spinal Artery
Anterior spinal:
- Medulla (pyramids, vestibular, hypoglossal, glossopharyngeal, and vagus)
- Contralateral hemiplegia (corticospinal – pyramids)
- Deviation of tongue to the affected side
- Dysphagia and loss of the gag reflex (glossopharyngeal and vagus)
- Nystagmus and balance disturbances (vestibular)
Cerebral Cortex
Functions:
- Initiates voluntary movements of face & limbs on contralateral side.
- Interprets sensation on contralateral side.
- Initiates voluntary eye movements to opposite direction.
- Interprets vision in the opposite field of both eyes.
- Dominant hemisphere (mostly L) initiates & interprets language.
Subcortical Areas
Functions:
- Connect cerebral cortex & brainstem.
- Consists of:
- deep WM, motor & sensory pathways for contralateral body
- basal ganglia, GM motor modifier, makes movements faster & smoother.
- 2 thalami, GM sensory relay station.
Deficits:
- Contralateral hemiparesis
- Contralateral hemisensory loss
- Sensorimotor deficit – combination of above 2
- Motor problems: incoordination, timing
Brainstem
Functions:
- Contains motor & sensory pathways for contralateral body.
- Relay station for the cerebellum to the ipsilateral body.
- Contains cranial nerves to ipsilateral face & head.
- Contains centers of consciousness & cardiopulmonary function
Deficits:
- Hemiparesis or quadriparesis
- Hemisensory loss or sensory loss in all four limbs
- Crossed signs – ipsilateral face & contralateral body involvement
- Eye mvmt abnormalities – diplopia, dysconjugate gaze, gaze palsy, eyes deviate to opposite direction
- Tinnitus, vertigo, nausea, vomiting
- Dysarthria, dysphagia, hiccups, abnormal respirations, breathing disturbances
- Decreased consciousness, sleep disturbances
Cerebellum
Functions:
- Coordination/motor learning center.
- Vermis
- Controls the trunk and gait balance.
- Cerebellar hemispheres:
- Coordination of the ipsilateral limbs.
