Types Of Stroke Flashcards
Presentation of inferior division mca stroke Motor loss? Aphasia? Eye deviation? Other?
Superior quadrantanopia or homonymous hemianopsia.
Dominant hemisphere/left side - wernicke’s aphasia
Nondominant hemisphere/right side - left visual hemineglect
What part of the brain when affected causes conduction aphasia
Parietal operculum supplied by inferior division of MCA
What separates superior from inferior division of mca
Sylvian sulcus
%age of cardiac emboli that go to brain
75%
Which arteries supply the medulla?
Vertebral arteries
Which stroke is most commonly associated with preceding TIA
Thrombotic
What arteries are occluded in lacunar strokes
Deep penetrating branches of large vessels
Weber Syndrome
What part of brain affected?
Motor loss?
CN involved?
Base of Midbrain stroke - Oculomotor nerve (CN3) palsy and contralateral hemiplegia, contralateral dystaxia, caused by interpeduncular branches of PCA.
Which arteries supply the pons and midbrain
Basilar artery
Presentation of one ACA Motor loss? Eye deviation? Aphasia? Other?
Contralateral muscle and sensory loss of lower extremity dismally.
Head and eye deviation toward lesion.
Urinary incontinence with contralateral grasp reflex and paratonic rigidity (gegenhalten).
Transcortical motor aphasia.
Gait apraxia
Gegenhalten
Paratonic rigidity - form of hypertonic with involuntary variable resistance with passive movement. Different from spasticity because there is no exaggerated DTR. Seen in ACA stroke
Branches of aortic arch
Brachiocephalic artery (which branches into R subclavian and R common carotid)
L common carotid artery
L subclavian artery
Which part of brain causes alexia with agraphia
Posterior parietal region, supplied by inferior division of MCA
Which strokes occur suddenly vs gradually?
Sudden = embolic and subarachnoid
Gradual = thrombotic and intracerebral
Sudden or gradual = lacunar
What does inferior division of mca supply?
Lateral temporal and inferior parietal lobes
Where is primary somatosensory cortex located
Prostcentral gyrus (behind central sulcus)
How do lacunar strokes present?
Pure motor or pure sensory
What does superior division of MCA supply?
Rolandic and pre-rolandic area
Which ischemic stroke occurs during sleep vs awake
Sleep = thrombotic Awake = embolic
What major vessels supply anterior circulation of brain
ICA, MCA, ACA
%age of ischemic vs hemorrhagic stroke
Ischemic = 85% hemorrhagic = 15%
Transcortical sensory aphasia
+fluency
-Comprehension
+Repetition
Caused by PCA stroke
Which stroke is due to a mural thrombus
Embolic
What cranial nerves are affected with PCA stroke
CN3 (oculumotor) and 4 (Trochlear)
%age of thrombotic vs embolic vs lacunar vs intracerebral vs subarachnoid
Thrombotic = 50% Embolic = 20% Lacunar = 15% Intracerebral = 10% Subarachnoid = 5%
Cardiac causes of embolic stroke
A fib, rhd, post-mi, vegetations on heart valves, endocarditis, prosthetic heart valves
Where does the PCA stem from?
Vertebral artery –> Basilar artery –> PCA
Anton Syndrome
Denial of cortical blindness, caused by PCA stroke
Prosopagnosia
Can’t read faces, caused by PCA stroke
What is the cause of amaurosis fugax
Transient monocular blindness results from ica occlusion as it nourishes the optic nerve and retina
What happens if both ACA is occluded?
Aphasia, paraplegia, incontinence, frontal lobe/personality dysfunction
Other causes of embolus other than cardiogenic
Fat embolus from fracture bones, air embolus from decompression sickness, venous clot from PFO, subclavian artery thrombosis to vertebral artery
Which stroke is associated with seizures
Embolic
Which artery supplies cerebellum
PICA from vertebral arteries
AICA and superior cerebellar arteries from basilar artery
Types of hemorrhagic strokes
Intracerebral and subarachnoid
Where is most common location for ICA to be occluded
First part of ICA immediately beyond carotid bifurcation
Which hemorrhagic stroke occurs when calm vs during activity
Calm = intracerebral Activity = subarachnoid
What artery is occluded in ocular infarction
Central retinal artery or retinal branch of ica
Where is primary motor cortex located
Precentral gyrus - in front of central sulcus
What part of ACA occlusion is well tolerated
Stem of ACA proximal to connection with anterior communicating artery because of collateral circulation with contralateral ACA
MCC of occlusion of superior division of MCA
Embolus
Types of ischemic strokes
Embolic, thrombotic, lacunae
Where are lacunar strokes mainly seen
Putamen, pons, thalamus, caudate nucleus, internal capsule
Palinopsia
Abnormal recurring visual imagery, caused by PCA stroke
What kind of aphasia is seen in vertebrobasilar strokes
No aphasias or cognitive deficits are seen
Presentation of distal ica occlusion:
Arteries involved?
ICA branches into MCA, so it may affect all or part of ipsilateral MCA, and part of ACA. Present with contralateral motor and/or sensory symptoms.
Presentation of superior division of MCA stroke: Motor loss? Eye deviation? Aphasia? Other?
Sensory and motor deficits of contralateral face and arm > leg.
Head and eyes deviate toward infarct.
dominant hemisphere - Global aphasia –> broca’s
Nondominant hemisphere - Spatial perception, hemineglect, constructional and dressing apraxia
Which division of MCA supplies broca’s area, and which supplies wernicke’s
Superior = broca's Inferior = wernicke's
