Stroke Syndromes (guest lecture)

Question 1

angiography

Answer 1

basilar tip aneurysm; source of patient’s hemorrhage

Question 2

subarachnoid hemorrhage (SAH)

Answer 2

bleeding in the arachnoid membrane; blood builds up between brain and skull and increases pressure; no vascular abnormality is found in ~15% of patients

Question 3

subarachnoid hemorrhage symptoms

Answer 3

sudden onset of severe! headache +/- nausea/vomiting
prodromal headache from minor blood leakage
photophobia and visual change
seizures in >25% of patients close to onset
meningeal signs seen in 75% (neck stiffness, low back pain, bilateral leg pain; can take several hours to develop)
loss of consciousness (~50% experience at the time of bleeding onset)

Question 4

location of seizure during SAH

Answer 4

has no relationship to the location of aneurysm

Question 5

Ophthalmologic signs in SAH

Answer 5

retinal hemorrhage, papilledema (swelling of optic disks in eyes)

Question 6

why loss of consciousness in SAH

Answer 6

transient intracranial circulatory arrest: the pressure impact of the hemorrhage increases intracranial pressure thus reduces Cerebral perfusion pressure

Question 7

Hunt-Hess and Fisher Scale

Answer 7

scale to classify severity of SAH

Question 8

Hunt-Hess and Fisher Scale: grade I

Answer 8

(hunt/hess) asymptomatic or minimal headache and slight nuchal rigidity; (fisher) no blood visualized;

asymptomatic or mild HA

Question 9

Hunt-Hess and Fisher scale: grade V

Answer 9

(Hunt/Hess) deep coma, decerebrate rigidity, moribund appearance: highest score very bad

coma; posturing or no motor response to pain

Question 10

MCA syndrome

Answer 10

stroke associated with middle artery syndrome

Question 11

MCA symptoms

Answer 11

contralateral weakness (face=trunk=arm=leg)
contralateral cortical sensory loss
homonymous hemianopsia or quadrantanopsia (visual defects)
Gaze preference
Dysphagia (difficulty swallowing)

Question 12

MCA syndrome: non-dominant

Answer 12

contralateral neglect and anosagnosia
visuospatial distortions
aprosody
apraxias

Question 13

MCA syndrome: dominant

Answer 13

global aphasia
apraxia

Question 14

Hemiplegia

Answer 14

paralysis affecting one side of the body (face, arm, trunk, leg)

Question 15

Hemiparesis

Answer 15

implies a lesser degree of weakness than hemiplegia

Question 16

Neglect

Answer 16

failure to attend to, respond to, and/or report stimulation that is introduced contralateral to the lesion
most often seen with non-dominant parietal association area lesions
affects contralateral side
persistent neglect is a negative functional outcome predictor

Question 17

Apraxia

Answer 17

loss of ability to execute skilled or learned movement patterns on command
in absence of weakness, sensory loss, comprehension, difficulty, abnormality of tone or posture, or cognitive deficit/decline
many types
multiple sites of possible injury

Question 18

Ideomotor Apraxia

Answer 18

plan for the movement is intact but the execution fails

due to damage within pathways connecting the areas in which the plan is conceived to those responsible for “innervating the engram”

dominant pre-motor area and dominant inferior parietal region implicated in contralateral ideomotor apraxia

bilateral apraxia may occur with unilateral lesions of the dominant supplementary motor cortex

Question 19

ACA syndrome

Answer 19

restriction of the anterior cerebral artery;

Question 20

ACA syndrome: unilateral

Answer 20

leg > arm motor loss (~90% of patients)
leg > face = arm cortical sensory loss
frontal release signs/inhibition of reflexes

Question 21

agnosia

Answer 21

acquired inability to associate a perceived unimodal stimulus (visual, auditory, tactile) with meaning

disorder or recognition NOT naming
knowing wheels, handlebars and a seat but not recognizing its a bike

Question 22

anosagnosia

Answer 22

example of agnosia; denial of deficit

Question 23

prosopagnosia

Answer 23

example of agnosia: impaired ability to recognize faces

Question 24

aphasia

Answer 24

impairment of language
associated with damage to the language dominant hemisphere
nearly always involves damage to the left fronto- temporal and/or temporo- parietal regions

Question 25

Intraparenchymal Hemorrhage

Answer 25

alteration in level of consciousness (~50%)
nausea and vomiting (~40-50%)
headache (~40%)
Seizures (~6-7%)