Stroke Flashcards
Stroke Definition
a clinical syndrome characterised by an acute loss of focal brain function that lasts more than 24 hours or leads to death
TIA Definition
a clinical syndrome characterised by an acute loss of focal brain function causing minimal tissue injury that lasts less than 24 hours
Haemorrhagic Stroke - causes
- arterial disease
- raised blood pressure
- bleeding diathesis
- haemorrhagic transformation of an infarct
BLEED
Ischaemic Stroke - causes
- large artery thromboembolism
- small artery disease
- embolism from the heart
- non atheromatous arterial disease
- blood disease
BLOCKAGE
more common
Stroke risk factors
- previous TIA/stroke
- diabetes
- atrial fibrillation
- hypertension
- smoking
- drug abuse
- valvular heart disease
- carotid stenosis
TOTAL ANTERIOR CIRCULATION SYNDROME
- hemiparesis with or without a sensory deficit involving at least 2 of 3 body areas
- homonymous visual field deficit
- higher cerebral/cortical dysfunction - dysphasia, neglect, visuospatial perceptual issues
Causes -
- infarct affecting MCA or ACA
- infarct affecting basal ganglia, cerebral cortex, internal capsule
PARTIAL ANTERIOR CIRCULATION SYNDROME
only 2 of 3 TACS components
- homonymous visual field deficit
- isolated higher cortical dysfunction
- motor/sensory deficit restricted to one body area
Causes -
- occlusion or damage to the MCA or ACA
LACUNAR SYNDROME
4 main types (never any cognitive or brainstem involvement)
- pure hemi motor loss in isolated body areas
- pure hemi sensory loss
- sensory (visual) or motor loss in isolated body areas with no other symptoms
- ataxis hemiparesis
Causes
- bleed or infarct in once of the small, deep penetrating arteries
- basal ganglia infarct
POSTERIOR CIRCULATION SYNDROME
signs of dysfunction of the brainstem, cerebellum, thalamus and/or occipital lobe
Possible Stroke Symptoms
MOTOR
- hemiparesis
- simultaneous bilateral weakness (rare)
- poor balance
- dysphagia
SPEECH
- receptive or expressive dysphasia
- dyslexia
- dysarthria
SENSORY
- hemisensory loss
- sensory inattention
- atereognosis
VISUAL
- monocular blindness
- hemianopia
- quadrantopia
- diplopia
- bilateral blindness
VESTIBULAR
- vertigo
- loss of equilibirum
MOTOR PLANNING
- apraxia
BEHAVIOURAL
- attention, memory, visuospatial
NON-FOCAL
- generalised weakness/sensory loss
- light headedness
- faintness
- confusion
- incontinence
Middle Cerebral Artery
Supplies the lateral cerebral cortex of all lobes Symptoms R - L hemiplegia - L sensory loss - L hemianopia/quadrantopia - visuospatial neglect/inattention - motor impersistence - impulsivity - disinterest/poor motivation - anasognosia - autopagnosia - dyspraxia - astereognosis - verticality problems - dysarthria more likely to have perceptual/visuospatial issues
L - R hemiplegia - R sensory loss - R hemianopia/quadrantopia - dysphagia - dysarthria - dyslexia - dyscalculia - dyspraxia more likely to be affected by dyspraxia and communication issues
Anterior Cerebral Artery
Supplies
- medial frontal and parietal lobes
- olfactory tract
- anterior hypothalamus
- caudate nucleus and putamen
- internal capsule
Symptoms
- contralateral hemiplegia
- cortical sensory loss on the contralateral side
- dyspraxia
- reduced ability to make decisions
- slow to respond to commands
- perseveration
- reduced speech output
- incontinence
- facial/tongue weakness
- grasp/sucking reflex
Posterior Communicating Artery
Supplies
- posterior limb of internal capsule
- medial thalamus
- central part of hypothalamus
- subthaalmus
- mamillary bodies
- optic chiasm
- lateral wall of 3rd ventricle
Symptoms
- visual disturbances
- hypothalamic dysfunction
- motor dysfunction
Posterior Inferior Cerebellar Artery
Supplies
- cerebellum
- medullary tracts
Wallenburg’s/Lateral Medullary Syndrome
- ipsilateral loss of pain and temperature sensation face
- contralateral loss of pain and temperature body
- diminished touch sensation
- transient contralateral paresis
- lateral rectus palsy
- ipsilateral paralysis of muscles of soft palate, pharynx and larynx
- dizziness, nausea and nystagmus
- cerebellar ataxia
- poor balance
- Horner’s syndrome
Posterior Cerebral Artery
Supplies
- posteriomedial parietal lobe
- corpus colossum
- inferior and medial part of temporal lobe
- medial and inferior surface occipital lobe
Ipsilateral Lesion
- homonymous hemianopia, visual inattention, visual anosognosia
- hemianaesthesia
- transient memory disturbances
- dyslexia
- dominant lesion = receptive aphasia
Weber’s/Medial Medullary Syndrome
