Physiological Psychology Lecture #7 (Guest Lecture-Strokes)

Question 1

Stroke

Answer 1

An interruption of normal blood flow to the brain.
- Leading cause of disability in adults.
- Third leading cause of mortality above ages 60-65
- Risk increases multifold with age.

Question 2

Angiography

Answer 2

basilar tip aneurysm, source of hemorrhage.

Question 3

Subarachnoid Hemorrhage

Answer 3

Sudden onset of severe headache with/without nausea/vomiting.

• Prodrominal headache from minor blood leakage reported in 30-50% of aneurysmal SAHs.
• Photophobia and visual changes.
• Seizures in >25% of patients close to onset.

Question 4

Ophthalmologic Signs in Subarachnoid Hemmorrhage

Answer 4

Retinal hemorrhage, papilledema.

Question 5

Meningeal Signs in Subarachnoid Hemorrhage

Answer 5

• Seen in over 75% of SAH
• Neck stiffness, low back pain, bilateral leg pain.
• May take several hours to develop.

Question 6

Loss of Consciousness Subarachnoid Hemmorrhage

Answer 6

About 50% of patients experience this at the time of bleeding onset.
- Due to transient inter-cranial circulatory arrest.
- The “percussive” blood pressure impact of the hemorrhage increase ICP (intercranial pressure) and therefore reduce CPP (cerebral perfusion pressure).

Question 7

Hunter-Hess Grade 1

Answer 7

Asymptomatic of minimal headache and slight nuchal rigidity.
-11% mortality rate.

Question 8

Hunter-Hess Grade 5

Answer 8

Deep coma, decerebrate rigidity.
- 100% mortality

Question 9

Middle Cerebral Artery (MCA) Ischemic Stroke

Answer 9

Contralateral weakness (face = trunk = arm = leg).
- posterior limbs of internal capsule, primary motor, and premotor cortex.

• Contralateral cortical sensory loss (parietal sensory cortex).
• Homonymous hemianopsia or quandrantanopia (optic radiation)
• Gaze preference (frontal eye fields)
• Dysphagia (motor strip)

Question 10

MCA Non-Dominant

Answer 10

• Contralateral neglect and anosagnosia (parietal association cortex)
• Visuospatial distortions (parieto-occipital association cortex)
• Aprosody (front-temporal and temporo-parietal cortex)
• Apraxias (acute confusional state with agitated delirium).

Question 11

MCA Dominant

Answer 11

• Global aphasia (fronto-temporal and temporo-parietal cortex)
• Apraxia.

Question 12

Aphasia

Answer 12

Caused by stokes in the left side of the brain that controls speech and language.

Question 13

Hemiplegia

Answer 13

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

Question 14

Hemiparesis

Answer 14

Implies a lesser degree of weakness than hemiplegia.

Question 15

Neglect

Answer 15

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 are lesions.
- Affects contralesional side.
- Persistent neglect is a negative functional outcome predictor.

Question 16

Apraxia

Answer 16

Loss of ability to execute skilled or learned movement patterns of command.
- In the absence of weakness, sensory loss, comprehension difficulty, abnormality of tone of posture, or cognitive deficit/decline.

• Many types of apraxia.
• Multiple sites of possible injury.
• Test by shaking someone’s hand–may be able to shake the hand but will not be bale to release the hand.

Question 17

Ideomotor Apraxia

Answer 17

plan for the movement is intact, but the execution fails.

Question 18

ACA Syndrome

Answer 18

Unilateral:
- Leg > arm motor loss (up to 90% of patients)

• Leg > face = arm cortical sensory loss
• Frontal release signs/inhibition of reflexes.

Question 19

Agnosia

Answer 19

Acquired inability to associate a perceived unimodal stimulus (visual, auditory, tactile) with meaning.
- Disorder of recognition (not naming)

Question 20

Anosagnosia

Answer 20

Denial od deficit

Question 21

Prosopagnosia

Answer 21

Impaired ability to recognize faces

Question 22

Aphasia

Answer 22

Impairment of language.
- Associated with damage to the language dominant hemisphere.
- Nearly always involves damage to the left front-temporal and/or temporo-parietal regions.

Question 23

Intraparenchymal Hemorrhage

Answer 23

Altercation in level of consciousness (~50%)

• Nausea and vomiting (~40-50%)
• Headache (~40%)
• Seizure (~6-7%)