Stroke Flashcards
What region has the highest stroke mortality and incidence rates in the U.S.?
Stroke belt - southeastern U.S. Stroke buckle (Georgia, carolinas) contains highest rates amongst the belt
Stroke vs. TIA
Stroke - acute loss of brain/monocular function with symptoms lasting > 24 hours
TIA - acute loss of brain/monocular function with symptoms lasting < 24 hours WITHOUT ischemic changes on imaging
Two types of strokes?
Ischemic stroke (embolic or thrombotic) accounts for majority of strokes. Most common ischemic stroke is lacunar stroke (small penetrating artery thrombosis due to HTN).
Hemorrhagic stroke less common but more deadly.
How do the vessels arise differently from aorta on left and right side?
Right side, common carotid and subclavian arise from brachiocephalic that comes off of aorta.
Left side, common carotid and subclavian comes directly off aorta.
What are the major branches of the internal carotid artery?
ICA provides anterior circulation.
Major branches include: ophthalmic artery, Pcomm, anterior choroidal artery, ACA, and MCA
What are the major sites of watershed infarct? What are some clinical manifestations of such infarcts?
ACA-MCA watershed.
MCA-PCA watershed.
“Man in the barrel” syndrome in which upper extremities are paralyzed with functional lower extremities.
MCA-PCA infarcts can cause disturbances of higher order visual processing.
What supplies the thalamus?
Deep branches of the PCA.
What part of the cortex does superior division of MCA supply?
Symptoms of left and right MCA superior division infarct?
Supplies lateral cortex above the sylvian fissure.
Left MCA - contralateral face/arm weakness, Broca’s aphasia, +/- contralateral sensory loss
Right MCA - contralateral face/arm weakness, left hemi-neglect (parietal lobe affected), +/- contralateral sensory loss
Symptoms of left and right MCA inferior division infarct?
Left MCA - Wernicke’s aphasia, right visual field defect
Right MCA - PROFOUND left hemi-neglect, left visual field loss, motor neglect with decreased voluntary/spontaneous initiation of movements on the left, right gaze preference
Left and right ACA infarct?
Left ACA - right LEG weakness/sensory loss, transcortical aphasia (ACA supplies corpus callosum!)
Right ACA - left LEG weakness/sensory loss, left hemi-neglect
Left and right PCA infarct?
Left PCA - right homonymous hemianopsia
Right PCA - left homonymous hemianopsia
Vascular supply for midbrain, medial pons, lateral pons, medial medulla, lateral medulla
Midbrain - PCA Medial pons - basilar artery Lateral pons - SCA or AICA Medial medulla - vertebral artery Lateral medulla - vertebral artery or PICA
Treatments for acute setting and time window?
IV TPA: 3-4.5 hours
Cath/endovascular management: 6 hours
Secondary prevention treatment options?
A1c Lipid panel Vascular imaging - CTA/MRA Antiplatelets - aspirin/clopidogrel Anticoagulation Surgical options
What diagnostic test should be performed with an initial negative result on CT and we suspect SAH?
Lumbar puncture–remember to look for xanthochromia!
