STROKE Flashcards
The patient complains of unsteadiness. On further examination you detect right facial numbness and right sided nystagmus. There is sensory loss of the left side.
lateral medullary syndrome aka wallenberg
what is lateral medullary syndrome
ipsilateral ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy ie horners
contralateral limb sensory loss
which vessel is affected in lateral medullary syndrome
posterior inferior cerebellar artery
anterior cerebral artery
Contralateral hemiparesis and sensory loss, lower extremity > upper
middle cerebral artery
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
posterior cerebral artery
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
branches of the posterior cerebral artery that supply the midbrain
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
Anterior inferior cerebellar artery (lateral pontine syndrome)
Symptoms are similar to Wallenberg’s (see above), but:
Ipsilateral: facial paralysis and deafness
retinal/opthalmic
amaurosis fugax
basilar artery
locked in syndrome
lacunar
present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
strong association with hypertension
common sites include the basal ganglia, thalamus and internal capsule
initial 3 ix you do when you suspect stroke
ECG
CXR
CT HEAD
TIA Ix
carotid doppler
what is the centrum semiovale
radiation of white matter tracts from internal capsule into corona radiata in parietal white matter
common complication of stroke
absent gag reflex causing aspiration of saliva/gastric contents
which type of infarct is the most common
thrombotic infarcts
what is paradoxical emboli
emboli occur when thrombus in the venous system or right side of the heart enter the arterial circulation usually through patent foramen ovale and cause infarction in the distal arterial circulation
the threshold to do carotid endarterectomy
more than 75% stenosis
when do you consider PEG tube
long term feeding and are unable to eat and drink and usually at a high risk of aspiration
what do u do in the acute setting of CVA
nasogastric tube
