Stroke Artery Territories & Aphasia Flashcards
What are the clinical features of an anterior cerebral artery stroke?
Contralateral hemiparesis and sensory loss
of low limbs
What are the clinical features of a middle cerebral artery stroke?
- Contralateral hemiparesis and sensory loss of upper limbs and face
sensory loss - Contralateral homonymous hemianopia
- ± Aphasia (Broca’s or Wernicke’s) if dominant hemisphere (L if RH)
- ± Contralateral hemispatial neglect
What are the clinical features of a posterior cerebral artery stroke?
- Contralateral homonymous hemianopia with macular sparing
- Contralateral loss of pain & temp (thalamic infarction)
What are the clinical features of a vertebrobasilar artery stroke?
- Ipsilateral cerebellar signs - DANISH
- Reduced consciousness (brainstem infarction)
- Quadriplegia/hemiplegia (brainstem infarction)
What does DANISH stand for?
- Dysdiadochokinesis
- Ataxia
- Nystagmus
- Intention tremor
- Slurred speech
- HYPOtonia
What are features of a total anterior circulation stroke?
- Unilateral motor and/or sensory deficit
- Homonymous hemianopia
- Higher cerebral dysfunction
What are features of a partial anterior circulation stroke?
2 of:
• Unilateral motor and/or sensory deficit
• Homonymous hemianopia
• Higher cerebral dysfunction
What are features of a posterior circulation stroke?
- CN palsy + contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Conjugate eye movement disorder
- Cerebellar impairment
- Isolated homonymous hemianopia
What are the 5 syndromes of a lacunar stroke?
1) Ataxic hemiparesis
2) Pure motor
3) Pure sensory
4) Sensorimotor
5) Dysarthria/clumsy hand
What is a key feature of lacunar strokes?
Cognition/consciousness intact EXCEPT in thalamic strokes
What are some features of brainstem infarcts?
- Quadriplegia
- Disturbances of gaze and vision
- Locked-in syndrome
What structures are affected in lacunar infarcts?
- Basal ganglia
- Internal capsule
- Thalamus
- Pons
What are the 4 types of aphasia?
1) Receptive (Wernicke’s)
2) Expressive (Broca’s)
3) Conduction
4) Global
What causes receptive/Wernicke’s aphasia?
Lesion of superior temporal gyrus (temporal lobe) supplied by inferior division of the left MCA
What causes expressive/Broca’s aphasia?
Lesion of the inferior frontal gyrus (frontal lobe) supplied by the superior division of the left MCA
What causes conduction aphasia?
Stroke affecting arcuate fasciculus - the connection bewteen Wernicke’s and Broca’s area
What is global aphasia?
- Large lesion affecting all 3 of the above areas resulting in severe expressive and receptive aphasia
- May still be able to communicate using gestures
What are the features of conduction aphasia?
- Speech is fluent but repetition is poor
- Aware of errors they are making
- Comprehension is normal
What are the features of Wernicke’s aphasia?
- Lesions result in sentences that make no sense, word substitution and neologisms but speech remains fluent - this area ‘forms’ the speech before ‘sending it’ to Broca’s area
- Comprehension is impaired
What are the features of Broca’s aphasia?
- Speech is non-fluent, laboured, and halting
- Comprehension is normal
