Stroke syndromes Flashcards

1
Q

What is an embolic stroke?

A

Masses formed elsewhere in the circulatory system travel through the bloodstream to block brain vessels of smaller diameter than the embolus

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2
Q

What is a thrombotic stroke?

A

Buildup of atherosclerotic plaques within vessel walls, resulting in gradual vessel occlusion

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3
Q

What is tissue plasminogen activator (tPA)?

A

Breaks up closse

Effectiveness significantly diminished >3 hours after infarct

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4
Q

What is an intracerebral hemorrhage?

A

Internal bleeding in the brain

can cause stroke

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5
Q

What are the most immediate pathogenic events in focal cerebral ischemia?

A

Anoxic depolarization

Excitotoxicity

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6
Q

What is a focal stroke characterized by?

A

Gradient of metabolic stress radiating from the core

Depolarizations become shorter-lasting as you move away from the core

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7
Q

How is the ischemic core defined?

A

Spread of anoxic depolarization

Peri-infarct depolarizations recover and recur in penumbra area surrounding ischemic core

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8
Q

What options must be considered when imaging a stroke?

A

Non-contrast CT - must be performed to rule out hemorrhage prior to tPA admin.

CT - widely available, rapid results

Diffusion-weighted MRI scans - much more accurate, but availability/cost must be considered

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9
Q

What is the penumbra?

A

Area immediately surrounding the dead core that is potentially salvageable with intervention

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10
Q

What is a lacunar infarct?

A

Small infacted area (end artery occlusion)

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11
Q

What is a watershed infarct?

A

Occlusion between 2 major artery distributions

E.g. MCA/PCA border

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12
Q

What is a transient ischemic attack?

A

Acute episode typically resolved within 30 minutes

Critically important to recognize diagnose, and treat

Highly predictive of a major stroke

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13
Q

What is amaurosis fugax?

A

Transient, unilateral loss of vision resulting from occlusion of the central retinal artery

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14
Q

What symptoms result from cortical strokes (i.e. large vessel strokes)?

A

Contralateral spastic limb and lower face paralysis with babinski

Contralateral fine touch and proioception loss

Ipsilateral vision loss

Aphasia if in dominant hemisphere

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15
Q

Describe middle cerebral artery strokes.

A

Three regions: Superior, inferior, deep

Primarily upper signs

Dominant hemisphere - global aphasia

Tongue deviation away from the side of the lesion

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16
Q

What is a stem infarct?

A

Proximal MCA occlusion covering all three regions; often present with gaze preference toward the side of the lesion

17
Q

Describe anterior cerebral artery strokes

A

Primarily lower signs that present as UMN weakness

Medial frontal lobe effects - abulia, akinetic mutism, urinary incontinence

18
Q

Describe posterior cerebral artery strokes

A

Contralateral homonymous hemianopsia

Memor deficits

Alexia without agraphia

19
Q

Describe subcortical strokes

A

Small vessel strokes

Smaller, more limited territories supplying deep white matter

Present similarly to cortical strokes, except for a lack of cortical signs

Lenticulostriate arteries supply genu and posterior limb of the IC

20
Q

Describe thalamic strokes

A

PCA, P. Comm., Ant. Choroidal

Wide range of symptoms

Contralateral homonymous hemianopsia - involving LGN

Thalamic syndrome - Extreme contralateral pain

21
Q

What differentiates brainstem from cortical strokes?

A

Brainstem presents with ipsilateral numbness instead of contralateral

22
Q

What is Weber’s syndrome?

A

Stroke involving penetrating branches of the PCA

Contralateral paresis/paralysis below neck

Ipsilateral oculomotor ophthalmoplegia

23
Q

What is Claude’s syndrome?

A

PCA/basilar artery stroke

Contralateral upper limb tremor, ipsilateral oculomotor ophthalmoplegia

24
Q

What is Benedikt’s syndrome?

A

Penetrating branches of the basilar artery

Combination of Weber’s and Claude’s

25
Describe a rostral pontine stroke
Contralateral spastic paresis with babinski in lower face and body
26
Describe a caudal pontine stroke
Ipsilateral whole facial paresis Medial strabismus Contralateral UMN signs (corticalspinal tract axons)
27
What is Locked-in syndrome?
Bilateral damage to basal pons due to massive basilar artery stroke Patient suffers complete paralysis but is not comatose because consciousness is spared
28
Describe a lateral medullary stroke
Wallenberg's syndrome - laryngeal muscles Contra loss of pain/temp body below neck Ipsi loss of pain/temp face Vestibular nuclei signs (nausea, vertigo)
29
Describe a medial medullary stroke
Involves medial lemniscus, pyramid, and exiting CN XII fibers Contra loss of fine touch, vibration, conscious proprioception Tongue deviation towards the side of the lesion
30
Describe Cerebellar strokes
Inability to walk; ataxia Dizziness, headache, nausea, vomiting