Stroke

Question 1

Cerebral thrombus

Answer 1

Ischemic stroke

Blockage that originates in cerebral vessel and causes obstruction; atherosclerotic

Large vessel- MCA, ICA

Small vessel- lacunar strokes d/t blockage of lenticulostriate arteries, medullary arteries

Question 2

Cerebral embolus

Answer 2

Ischemic stroke

Clot that travels to the brain from another area

Heart– a-fib, valvular disease

ICA– originates at bifurcation of common carotid artery

Question 3

Cerebral perfusion pressure

Answer 3

Low pressure results in ischemic stroke

40-50mmHg

Cardiac arrest, shock

Possible watershed stroke- blood fails to reach arteries on the outer areas of the brain

Question 4

ABCD2 Prediction Rule

Answer 4

Age >60 (1)
BP =/>140/90. (1)
Clinical presentation:
-unilateral weakness, with or without speech (2)
-Speech impairment without unilateral weakness
Duration: >/= 60 mins (1)
Diabetes (1)

Question 5

Intracerebral Hemorrhage

Answer 5

Rupture of blood vessels within the brain

Common locations: basal ganglia, cerebellum, brainstem, cortex

Causes/risk factors: HTN, drug use, anticoagulant use

Question 6

Subarachnoid hemorrhage

Answer 6

Rupture of vessels in the subarachnoid space, btw the brain and the skull

Sx’s: sudden onset of “thunder clap HA’, neck pain, n/v

Common cause: cerebral aneurysm

Most deadly

Question 7

Saccular aneurysm

Answer 7

Rounded/irregular swellings in arteries that are less resistant to changes in pressure

Common locations: vessel bifurcation- sheer forces
ACA; ICA/PCA

Aneurysm w/ diameter of =/>10mm are at critical risk of rupture.

Question 8

Arteriorvenous malformation

Answer 8

Congenital defect- abnormal tangle of blood vessels

Question 9

Middle Cerebral Artery

Answer 9

Most common stroke location

Supplies: primary motor/sensory cortices, Broca’s/Wernicke’s Aphasia

-Contralateral face/arm>LE weakness
-Contralateral loss of sensation UE and face>LE
-Contralateral homonymous hemianopsia
-Non-dominant- neglect and impairment of nonverbal communication
-

Question 10

Lacunar Stroke

Answer 10

Caused by chronic HTN

Lenticulostriate arteries

Supplies: basal ganglia and internal capsule

Contralateral weakness

Question 11

Posterior Cerebral Artery

Answer 11

Supplies: occipital lobe, inferior part of temporal lobe, deep structures diencephalon- thalamus

-Contralateral weakness
-Contralateral Homonymous hemianopsia
-Contralat eye paresis
-Calcerine sulcus- blindness of contralat visual field
-Thalamic syndrome- severe pain, contrast loss of sensation, flaccid hemiparesis
-Hippocampus- impairs declarative memory

Question 12

Anterior Cerebral Artery

Answer 12

RARE d/t collateral circulation of ant communicating artery

Supplies: primary motor and sensory cortices (mainly lower limb), supplementary motor area, prefrontal cortex

-Contralateral weakness LE>UE/face, causing incontinence
-Frontal lobe behavioral abnormalities- poor judgment, decreased attention/motivation, difficulty regulating emotions, apraxia

Question 13

Watershed Stroke

Answer 13

Results from hypo perfusion- heart disease, cardiac arrest, shock

Proximal arm/leg weakness w/ preservation of distal strength (main in a barrel)

Question 14

Posterior Inferior Cerebellar Artery

Answer 14

Lateral Medullary Syndrome aka
Wallenberg Syndrome

Supplies: cerebellum, medulla

-Ipsi ataxia
-Contralat weakness
-Contralat loss of pain/temperature in body, ipsi face
-Dizziness/vertigo
-Diploplia
-Dysphagia
-Dysarthria
-Ipsi Horner’s syndrome- ptosis, pupil constriction, decreased sweating

Question 15

Anterior Inferior Cerebellar Artery

Answer 15

Lateral pontine syndrome

Supplies: cerebellum, CN VII and VIII

-Ipsilat ataxia
-Contralat weakness
-Contralat sensory impairment (pain and temp)
-Dizziness/vertigo

Question 16

Patterns of Sensory Loss
Dissociated

Answer 16

CN signs opposite long tract signs –> brainstem disorder

Loss of pain and temperature, vibration, touch, position on different sides of body –> SCI

Question 17

Patterns of Sensory Loss
Global

Answer 17

Impairments of all sensory modalities on one side of body, plus UMN signs–> cortical injury

Impairments of all sensory modalties on one side of body, plus LMN signs– peripheral nerve injury

Question 18

Supratentorial

Answer 18

Damage to cerebral cortex or diencephalon

Results in cognitive, judgment, affect, and/or language deficits

Question 19

Infratentorial

Answer 19

Damage to brainstem or cerebellum

Results in abnormal vital signs, automatic movement, adjustments, posture/gait, and/or breathing patterns

Question 20

Anosognosia

Answer 20

Denial of symptoms

Often present in patients with neglect

Associated with damage to the R posterior ínsula

Question 21

Somatotopagnosia

Answer 21

Lack of awareness of body structure and relationship of body parts in self and others

Most common with damage to L parietal area and temporal lobe

Question 22

Finger agnosia

Answer 22

Inability to name, touch, identify specific fingers on self or others

Question 23

Apraxia

Answer 23

Inability to perform purposeful movement despite adequate strength, coordination and sensation.

Question 24

Ideomotor apraxia

Answer 24

Difficulty planning and completing tasks on command

Question 25

Ideational apraxia

Answer 25

Inability to conceptualize or perform tasks on command or automatically.

Question 26

Gerstmann Syndrome

Answer 26

Symptoms related to damage to parietal lobe near angular gyrus
-R/L discrimination disorder
-Finger agnosia
-Agraphia
-Acalculia