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Board Review > Stroke > Flashcards

Stroke Flashcards

1
Q

Name the four phases of swallowing and the associated problems seen in each.

A
  1. Oral Preparatory phase
    - voluntary, prepares bolus
    - Drooling, pocketing
  2. Oral Phase
    - Voluntary, Moves bolus towards the oropharynx
    - Drooling, Pocketing, Head tilt
  3. Pharyngeal Phase
    - Reflex
    - food sticking, choking and coughing, aspiration, wet gurgling voice, nasal regurgitation
  4. Esophageal Phase
    - reflex, longest phase
    - Heartburn, food sticking
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2
Q

List several common compensatory strategies for dysphagia

A
  1. Chin Tuck
  2. Head Rotation
  3. Supraglottic Swallow
  4. Super supraglottic swallow
  5. Mendelsohn maneuver
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3
Q

Weber Syndrome

A
  • Base of midbrain
  • Obstruction of interpeduncular branches of PCA or posterior choroidal artery, or both.
  • Results in ipsilateral CN3 paralysis.
  • Contralateral: hemiplegia, Parkinson signs, dystaxia
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4
Q

Millard-Gubler Syndrome

A
  • Base of Pons
  • Obstruction of circumferential branches of basilar artery. Involvement of white matter track leads to contralateral hemiplegia.
  • Ipsilateral nerve plays: CN 6, 7
  • Contralateral: hemiplegia, analgesia, hypoestheisa
  • if there’s extension into the medial lemniscus, patient will display Raymond-Foville Syndrome with gaze palsy towards the side of lesion
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5
Q

Medial Medullary Syndrome

A
  • Medial Medulla
  • Infarct to penetrating branches of vertebral arteries anterior spinal artery
  • Ipsilateral hypoglossal palsy with deviation towards side of lesion
  • contralateral hemiparesis and proprioception/position sense loss
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6
Q

Anterior Cerebral Artery Infarct proximal to ACA vs distal

A

Proximal infarcts is usually well tolerated due to collateral circulation from the the contralateral ACA. Distal infarct will result in C/L weakness and sensory loss that’s most prominent in the distal LE. There is mild to no UE involvement. Patients may have urinary incontinence (lack of inhibition) w/ contralateral grasp reflex and paratonic rigidity. On exam, they may exhibit a head and eye deviation towards the side of the lesion. Can see changes in personality, concentration due to frontal lobe involvement. May see transcortical motor aphasia if on left side.

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7
Q

Inferior MCA Division infarct

A

Affects blood supply to lat. temporal and inferior parietal lobes.

  • Quadrantanopia or homonymous hemianopsia
  • Left side lesion: Wernicke’s aphasia
  • right side lesion: Left visual neglect
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8
Q

Superior MCA Division Infarct

A

Affects blood supply to Rolandic and pre-Rolandic areas. Most commonly caused by embolus.

  • contralateral motor+sensory deficits face/arm >leg
  • Head/eye deviations towards lesion
  • Left side lesion: global aphasia -> Broca
  • Right side lesion: Hemineglect, spatial deficits, constructional and dressing apraxia
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9
Q

ICA infarct

A

Variable presentation; 30-40% are asymptomatic.

  • associated with ocular infracts, Transient monocular blindness.
  • Distal occlusion in setting of a small Anterior Communicating Artery, patient will present with c/l motor and /or sensory symptoms d/t involvement of ipsilateral MCA territory.
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10
Q

Lateral Medullary (Wallenberg) Syndrome

A

Occlusion of any of the following: Vertebral Arteries,, PICA, Medullary Artery. Presents with ipsilateral: Horner’s, Dec pain/temp sensation in face, Cerebellar signs. Contralateral Dec pain/temp on c/l mood, dysphagia, dysarthria, hoarseness, paralysis of vocal cord, vertigo, N/V, Hiccups, Nystagmus and diplopia.

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11
Q

Explain the symptoms associated with Lateral Medullary Syndrome and neurologic anatomy involved

A

Ipsilateral Sensory loss – face pain/temp/CN 5 nucleus
Ipsilateral Facial pain/CN 5 nucleus
Ipsilateral Ataxia –arm and leg/Restiform body, cerebellum
Ipsilateral Gait ataxia/Restiform body, cerebellum
Ipsilateral Nystagmus/Vestibular nucleus
Ipsilateral Nausea, vomiting/Vestibular nucleus
Ipsilateral Vertigo/Vestibular nucleus
Ipsilateral Hoarseness/Nucleus ambiguous
Ipsilateral Dysphagia -Nucleus ambiguous
Ipsilateral Horner syndrome - Descending sympathetics
Contralateral/Hemisensory loss–pain/temp: Spinothalamic tract
Neither Hiccups (possible vagus)

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12
Q

Treatment for Thalamic Pain syndrome

A

Gabapentin/Lyrica
SNRI
TCA
Modality: Desensitization (first-line)

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13
Q

Non-modifiable Risk Factors fro Stroke

A
  1. Age, Risk more than doubles each decade after 55.
  2. Sex (m>f)
  3. Race (AA 2x>Whites>Asians)
  4. Family history
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14
Q

Modifiable Stroke Risk Factors

A
  1. Hypertension
  2. Prior TIA
  3. Heart Disease
  4. Atrial Fibrillation
  5. Diabetes
  6. Smoking
  7. Carotid Stenosis
  8. OCP and Smoking
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Board Review (6 decks)

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