Stroke Review Flashcards
The sources supplying the circle of willis are the:
internal carotid arteries, basilar artery
The _____ artery supplies the medial, frontal, and parietal lobes
ACA
The _____ artery supplies the medial temporal and occipital lobes
PCA
The area of the precentral gyrus closest to the lingula is responsible for _______ (function) of the ________
motor; jaw, tongue and throat
70% of strokes are due to ______ occlusion or rupture
MCA
Another name for the branches of ______ is M2
MCA
The cerebellum is supplied by these 3 arteries:
superior cerebellar artery (SCA), AICA, PICA
The anterior limb of the internal capsule is supplied by the _______ arteries
lenticulostriate arteries
The posterior limb of the internal capsule is supplied by the _______ and _______ arteries
lenticulostriate, anterior choroidal
anterior choroidal artery is a branch of _______
internal carotid
A transient ischemic attack is defined as _________ and typically lasts _________ minutes
less than 24 hours with no brain damage, 15-20 minutes
A stroke is defined as ____________
more than 24 hours WITH brain damage
An ABCD^2 score of 6 equals a _______ risk of stroke over a 7 day period after a TIA
11%
The highest ABCD^2 score one can achieve is ____
9
The last 2 D’s in the ABCD^2 score stand for:
duration (≥10 minutes = 1pt; ≥60 minutes = 2pt), Diabetes (yes = 1pt)
A stroke of the internal capsule is referred to as a ______
capsular stroke
Occlusion of the __________ also leads to difficulty localizing and interpreting sounds
lenticulostriate arteries (because they also supply the sublenticular limb of IC)
The ________ (artery) is the most common site of spontaneous hypertensive hemorrhage in individuals with long-standing hypertension
lenticulostriate arteries
A person with chronic hypertension has a stroke, what symptom are they likely experiencing?
difficulty localizing and interpreting sounds
________ is the most frequent UMN syndrome
capsular stroke
UMN signs of capsular stroke are ________ and __________
UMN signs for contralateral UE and LE, UMN signs for contralateral face and neck
In a lesion to the CNT occurring in the internal capsule, the sidedness of the lesion to the UMN sign is:
bilateral
The ______ which also runs through the internal capsule contains fibers of the trigeminal motor nucleus, facial motor nucleus, nucleus ambiguus, accessory nucleus, and hypoglossal nucleus
CNT
If the CNT fibers in the internal capsule are lesioned, the damage to the facial motor nucleus, nucleus ambiguus, and hypoglossal nucleus causes _______ (sidedness) UMN signs
contralateral
The clinical signs of a lesion to the CNT fibers (specifically of CN V, CN VII, and CN X) in the internal capsule are _______, _________, and ________________________________
brisk jaw jerk reflex (V); spastic paralysis of lower facial muscles (VII); uvula deviates ipsilateral to lesion, dysarthria, difficulty swallowing
The clinical signs of a lesion to the CNT fibers (specifically to CN XI and XII) running in the internal capsule are __________ and _________
difficulty raising shoulder, difficulty turning head contralateral to lesion; tongue deviates contralateral to lesion
A patient has contralateral hemianesthesia of the left UE, LE, and face. Where is the lesion?
internal capsule
A patient has a right lateral medullary lesion, what 2 somatosensory symptoms will he have?
ipsilateral facial pain loss, contralateral UE and LE pain loss
A patient has a lesion to their spinal cord, what 2 somatosensory symptoms will they have?
ipsilateral touch loss, contralateral pain loss
An optic sign of MCA superior trunk stroke is ________ due to _________
contralateral gaze palsy or gaze preference toward side of lesion, damage to frontal eye field
A patient presents with dimished problem-solving ability. What is she suffering from and what artery is involved?
Broca’s aphasia, MCA superior trunk
A visual symptom of _______ stroke is contralateral superior quadrantanopia
MCA inferior trunk
The MCA inferior trunk supplies the ____________ and the _____________
lateral hemisphere inferior to lateral fissure, parietal lobe posterior to postcentral gyrus
A patient presents who always bumping into walls when trying to walk to the right, and has been having a hard time finding his dog around the house and says he would normally find her by listening for her whining. What type of stroke did this man probably suffer?
MCA inferior trunk stroke
The 3 key clinical signs of an MCA inferior trunk stroke are:
Wernike aphasia (if left hemisphere), contralateral neglect, difficulty localizing and interpreting sounds
A patient presents with loss of pin prick and vibratory sensation to the left UE and face, as well as spastic paralysis of her left arm and left facial paralysis. What type of stroke did she have?
MCA distal stem stroke
MCA distal stem supplies the:
lateral hemisphere
A patient with MCA distal stem stroke history will have _________ gaze palsy with __________ gaze preference
contralateral, ipsilateral
An MCA distal stem stroke causes ___________ -anopia because it affects the _________
contralateral superior quadrantanopia, inferior optic temporal radiation including Meyer’s Loop (yes really, I know it’s weird but you didn’t make a mistake on this card)
A patient presents with global aphasia, diminished problem solving ability, hemineglect, and difficulty localizing and interpreting sounds. What type of stroke did they suffer?
MCA distal stem stroke
A patient who just had an MCA proximal stem stroke will present with UMN signs for __________ and UMN signs for __________.
They will also have somatosensory signs of hemianesthesia of the ____________
contralateral UE and LE, contralateral face and neck, contralateral UE, LE, and face
The MCA proximal stem supplies the:
posterior limb of internal capsule and lateral hemisphere
A person presents with left homonymous hemianopia and apparently had a stroke involving the MCA. What portion of MCA was affected?
MCA proximal stem
The _______ supplies the medial hemisphere anterior to the occipital lobe
anterior cerebral artery
A patient presents with spastic hemiplegia of the left LE. He also has loss of pin prick and vibratory sensation for the left LE. On further exam it is found that he is emotionally unstable. What kind of stroke did he have?
Anterior cerebral artery (ACA) stroke
A patient is crying uncontrollably one moment and then becomes enraged the next. He also has weakness in the right leg. What kind of stroke did he probably have?
ACA stroke
The optic tract, retrolenticular limb of IC, inferior portion of posterior limb of IC, hippocampus, and the amygdala are lesioned with occlusion of this artery:
anterior choroidal artery
A patient presents with weakness to their contralateral UE and LE, contralateral homonymous hemianopia, transient anterograde amnesia, and transient emotional instability. What type of stroke did they have?
anterior choroidal artery stroke
A lesion to PCA produces this visual clinical sign:
contralateral homonymous hemianopia (due to lesion of LGN)
The PCA supplies the ________ and _________
medial hemisphere occipital and temporal lobes, midbrain
These 5 structures can be found in the lateral midbrain:
ALS, medial lemniscus, ATTT, substantia nigra, crus cerebri
These 5 structures can be found in the medial midbrain:
CN III or oculomotor nucleus, red nucleus, cerebellothalamic fibers, substantia nigra, crus cerebri
These 3 syndromes are caused by a PCA stroke:
weber syndrome, claude syndrome, benedikt syndrome
Signs of lateral midbrain damage after a PCA stroke are the following 3:
contralateral hemianesthesia including face, contralateral tremor, possible contralateral plegia or paresis of LE
The mainly medial PCA stroke syndrome of the midbrain is:
claude syndrome
Occlusion of the thalamogeniculate artery leads to the following 4 possible symptoms:
contralateral hemianesthesia including face, contralateral homonymous hemianopia, difficulty localizing and interpreting sounds, thalamic pain syndrome
In alternating hemiplegias the lesion involves the __________ and _______, _______, or _________
corticospinal system (UMN’s), CN III, CN VI, CN XII
In alternating hemiplegias, the symptoms include __________ and ____________
contralateral spastic paralysis, ipsilateral deficit of cranial nerve
superior alternating hemiplegia involves lesion to the _________ and the ________
CST (UMNs), CN III (LMNs)
superior alternating hemiplegia causes these 5 symptoms:
contralateral spastic paralysis (UMNs), ipsilateral deficit of CN III (LMNs), lateral strabismus, contralateral ataxia, and cerebellar outflow tremor
One very obvious sign of superior alternating hemiplegia is:
ipsilateral eye is down and out
UMN signs for the face and neck which are apparent in __________ are:
brisk jaw jerk reflex, spastic paralysis of lower face, uvula deviates ipsilateral to lesion, tongue deviates contralateral to lesion, difficulty raising ipsilateral shoulder, difficulty turning head contralateral to paralysis
superior alternating hemiplegia
One key UMN sign of superior alternating hemiplegia is:
brisk jaw jerk reflex
Middle alternating hemiplegia is also referred to as _______
Foville syndrome
_____________ involves lesion to the CST (UMNs) and CN VI (LMNs)
middle alternating hemiplegia (Foville syndrome)
A patient presents with contralateral spastic paralysis, ipsilateral deficit of CN VI, medial strabismus andhorizontal gaze palsy, and contralateral loss of tactile sensation to UE and LE. What is the diagnosis?
middle alternating hemiplegia
UMN signs for face and neck in _________ are:
uvula deviates ipsilateral to lesion, tongue deviates contralateral to lesion, difficulty raising ipsilateral shoulder, difficulty turning head contralateral to paralysis
middle alternating hemiplegia
inferior alternating hemiplegia is also referred to as ________
medial medullary syndrome
inferior alternating hemiplegia involves lesion to _____ and ______
CST, CN XII
A person with inferior alternating hemiplegia will have motor signs of _________ and _________, as well as sensory sign of __________
contralateral spastic paralysis, ipsilateral deficit of CN XII, contralateral loss of tactile sensation of UE and LE
UMN signs of the face and neck for ___________ are difficulty raising ipsilateral shoulder and difficulty turning head contralateral to paralysis
inferior alternating hemiplegia
UMN signs of the face and neck in inferior alternating hemiplegia are ___________ and ___________
difficulty raising ipsilateral shoulder, difficulty turning head contralateral to paralysis
Wallenberg syndrome is due to occlusion of the __________, while inferior alternating hemiplegia is due to occlusion of ____________
vertebral artery or PICA, branch of ASA (anterior spinal artery)
sensory signs of lateral medullary syndrome (wallenberg syndrome) are:
contralateral pain and temperature loss of body, ipsilateral pain and temperature loss for face
motor and other signs of lateral medullary syndrome (wallenberg syndrome) are:
ipsilateral horner syndrome, hoarseness and contralateral deviation of uvula, contralateral nystagmus, vertigo, nausea, vomiting, ataxia
Signs that originate from damage to the nucleus ambiguus in lateral medullary syndrome are ___________
hoarseness and contralateral deviation of uvula
Horner syndrome is a result of the linkage between the _______ and the __________ being severed
hypothalamus, ANS
The 3 possible areas of damage that produce Horner syndrome are:
hypothalamospinal neurons, preganglionic sympathetic neurons (T1-T3), and postganglionic sympathetic neurons (SCG)
Horner syndrome due to damage to ____________ can happen in lateral medullary syndrome or cervical spinal cord transection
hypothalamospinal neurons
Horner syndrome due to damage to _______________ can occur due to a sympathetic chain compression or thoracic spinal cord transection
preganglionic sympathetic neurons (T1-T3)
Horner syndrome due to damage to _________ can be due to cavernous sinus tumor, carotid artery dissection, or jugular foramen syndromes
postganglionic sympathetic neurons (SCG)
Likely clinical signs of ___________ are contralateral hemianalgesia, ipsilateral facial hemianalgesia, contralateral nystagmus, nausea, vomiting, vertigo, ataxia, ipsilateral horner syndrome, ipsilateral facial hemiparesis, and ipsilateral nerve deafness
AICA syndrome
A patient is found to have left-sided hemianalgesia and right-sided facial hemianalgesia. It is also noted that he has right-sided facial hemiparesis and right-sided nerve deafness. What is the diagnosis?
AICA syndrome
A patient is found to have right-sided hemianalgesia and left-sided facial hemianalgesia. He is also found to have right-sided deviation of the uvula and hoarseness. What is the diagnosis?
Wallenberg syndrome (lateral medullary syndrome)
