Week 7 - Stroke Syndromes

Question 1

Two types of hemorrhages

Answer 1

Subarachnoid

Intraparenchymal

Question 2

Subarachnoid hemorrhage: Symptoms

Answer 2

Sudden onset of a severe headaches +/- nausea/vomiting (could include photobhobia and visual change)

Seizure: 25% patients exp. (location of seizure has no relation to location of aneurysm)

ophthalmologic signs (Retinal hemorrhage, papilledema)

Meningeal signs seen in over 75% of SAH
* neck stiffness, low back pain, bilateral leg pain
* may take several hours to develop

Loss of consciousness: 50% of patients experience this at time of bleeding onset

Question 3

Angiography

Answer 3

basilar tip aneurysm, source of the patient’s hemorrhage.

If aneurysm ruptures, stroke

Question 4

Why loss of consciousness in SAH

Answer 4

the ‘percussive’ blood pressure impact of the hemorrhage increase ICP (intracranial pressure) and therefore reduces CPP (cerebral perfusion pressure)

Question 5

Hunt-Hess and Fischer Scale

Answer 5

The Hunt and Hess scale: describes the clinical severity of subarachnoid hemorrhage resulting from the rupture of an intracerebral aneurysm and is used as a predictor of survival. SYMPTOMS

The Fisher scale: classifying the amount of subarachnoid hemorrhage on CT scans, and is useful in predicting the occurrence and severity of cerebral vasospasm. CT SCAN

Question 6

Hunt-Hess and Fischer Scale: grade I and grade V

Answer 6

Grade 1:
- Hunt/Hess: asymptomatic or minimal headache, slight rigidity
- Fischer: no blood seen

Grade 5:
- Hunt/Hess: deep coma (posturing or no motor response to pain) –> 100 mortality in one study or something
- Fischer:

Question 7

MCA Syndrome

Answer 7

Contralateral weakness

Contralateral cortical sensory loss

homonymous hemianopsia or quadrantanopsia

gaze preference

dysphagia (difficulty swallowing)

Question 8

MCA Syndrome: Non-domiant

Answer 8

Contralateral neglect and anosagnosia (unaware of issues)

Visuospatial distortions

Aprosody (ability to either produce or comprehend the affective components of speech or gesture)

Apraxis (loss of ability to execute or carry out skilled movement and gestures)

Question 9

MCA Syndrome: Domiant

Answer 9

global aphasia (loss of ability to understand or express speech)

Apraxia (loss of ability to execute or carry out skilled movement and gestures)

Question 10

Hemiplegia vs Hemiparesis

Answer 10

LEARN

Hemiplegia: Paralysis affecting one side of the body (Face, arm, trunk, leg)

Hemiparesis: Implies a lesser degree of weakness than hemiplegia (weakness not paralysis)

Question 11

Neglect

Answer 11

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 contralesional side.

Persistent neglect is a negative functional outcome predictor

Question 12

Apraxia

Answer 12

Loss of ability to execute skilled or learned movement patterns on command (in the absence of weakness, sensory loss, comprehension difficulty, abnormality of tone or posture, or cognitive deficit/decline)

• Many types of apraxia described.
• Multiple sites of possible injury.

Question 13

Ideomotor Apraxia

Answer 13

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 14

ACA Syndrome

Answer 14

Unilateral
* Leg > arm motor loss (up to 90% of patients
* Leg > face = arm cortical sensory loss
* Frontal release signs/inhibition of reflexes

Question 15

Agnosia

Answer 15

Acquired inability to associate a perceived unimodal stimulus (i.e. visual, auditory,
tactile) with meaning.

Disorder of recognition (not naming)

AKA can you recognize something?

Question 16

Anosagnosia

Answer 16

denial of deficit

(can’t recognize that something is wrong)

Question 17

Prosopagnosia

Answer 17

impaired ability to
recognize faces

Question 18

Aphasia

Answer 18

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 19

Intraparenchymal Hemorrhage

Answer 19

Alteration in level of consciousness (~50%)

Nausea and vomiting (~40- 50%)

Headache (~40%)

Seizures (~6-7%)

Question 20

Summary slide

Answer 20

Question 21

IPH vs SAH

Answer 21

Subarachnoid hemorrhage is the leakage of blood into the subarachnoid space, most often due to a ruptured intracranial aneurysm. The classic presentation is a sudden, severe headache.

Intracerebral hemorrhage, or hemorrhagic stroke, typically presents as an acute neurologic deficit, often accompanied by headache.