Stroke Flashcards
Lacunar infarct
Due to atheromatous disease of small perforator vessels to deep white matter (usually corona radiata or internal capsule, basal ganglia, thalamus and pons. Very rarely embolic.
Higher cortical function not affected
Pure motor hemiparesis
Sensorimotor
Pure sensory (usually thalamic infarction)
Ataxia-Hemiparesis (ataxia worse than paresis) (often brainstem)
Dysarthria
Other syndromes eg hemiballismus, Dystonia, eyes
Posterior circulation infarct
Supplies posterior inferior cerebellar artery (PICA), Anterior inferior cerebellar artery (AICA), superior cerebellar artery (SCA) and posterior cerebral artery (PCA)
PICA syndrome
Ipsilateral facial and contralateral trunk and limb spinothalamic impairment
Dysphagia, hoarseness and loss I gag reflex
Vertigo, nausea, vomiting, nystagmus and diplopia
Ipsilateral horners syndrome and cerebellar signs
AICA syndrome
Ipsilateral sensory loss of face
Contralateral limb and trunk spinothalamic loss
Paralysis of ipsilateral face and jaw muscles
Ipsilateral hemi-ataxia
PCA occlusion (supplies inferior, medial temporal lobe and occipital cortex)
Contralateral hemianopia often with macular sparing
Contralateral spinothalamic loss
Memory deficits
Cortical blindness, visual hemineglect and other higher cortical deficits
Dominant hemisphere infarction May cause aphasia with ir without alexia but without agraphia
Larger infarcts involving the thalamus and internal capsule may cause contralateral henisensory loss and hemiparesis
Too of the Basilar syndrome
Embolic infarction of midbrain
Loss of vertical eye movements
Pupillary abnormalities
Coma
Locked in syndrome
Spinal cord infarction
Anterior spinal artery most commonly affected and supplies anterior 2/3
Largest one is artery of adamkiewicz t9-11 but commonest affected is upper Thoracic cord as this is a watershed area
Signs:
Acute flaccid paraparesis (can become spastic later)
Loss of sphincter control
Spinothalamic impairment with preservation of dorsal
