cerebral and lacunar strokes Flashcards
(19 cards)
what are the general causes of stroke ?
ischemic
hemorrhagic
what is the first best test used for the diagnosis of stroke ?
non contrast CT of the head
what are the main cerebral arteries ?
MCA
ACA
PCA
what are the areas supplied by the MCA, ACA and PCA ?
MCA - upper limb and face - the side of the brain the lateral
ACA - lower limb - the frontal lobe
PCA - vision - occipital lobe
what are the component sof the circle of willis ?
the ACA , MCA and PCA
what does an MCA stroke present with ?
theres dominant and non dominant MCA strokes
dominant MCA stroke - can lead to wernickes or Broca’s aphasia
non dominant MCA stroke - can cause hemispatial neglect , inability to draw a full clock
generally - contralateral motor and sensory sensation is lost
what is the pathology behinds bells palsy ?
upper face has a dual supply - dual UMN supply
the lower face has a single UMN suply
so in MCA cases the lower face only is affected
what is the presentation of an ACA stroke ?
motor/sensory abnormalities of the contralateral leg
what is the presentation of a PCA stroke ?
bilateral (contralateral) hemaniopia with macular sparing
visual hallucinations
visual agnosia
right PCA - left hemaniopia
left PCA - right hemaniopia
what is the thalamic syndrome ?
always happens after a stroke especially if the stroke is in the PCA affecting the lateral thalamus
contralateral sensory loss in the face arms and legs
no motor deficits
associated with chronic pain on the contralateral side
what is the cause and presentation of hypoxic encephalopathy ?
causes : anemia
shock
repeated hypoglycemia
loss of CNS blood flow leading to loss of consciousness for less than 10 secs , permanent damage happens after 4 minutes
what are the areas damaged when it comes to hypoxic encephalopathy ?
hippocampus (pyramidal cells ) first area affected
cerebellum (purkinjie fibres) are also highly susceptible
what are the watershed areas of each organ ?
brain - ACA,MCA and PCA boundaries
heart - subendocardium of the LV
liver - zone 3 around the central vein
kidney - the straight part of the proximal tubule , thick ascending limb
colon - splenic flexure and rectosigmoid junction
what is the classic scenario associated with affection of the watershed area of the brain ?
CNS damage after a massive MI
what is the presentation of some one who suffers from ischemia in the watershed areas of the brain ?
weakness of the shoulder and thighs
sparing of the face, hands and feet
bilateral symptoms
a man in the barrel
what are lacunar strokes mostly associated with ?
hypertension causing lypohyalinosis leading to necrosis and reabsorption of tissue , smoking and DM - they lack cortical signs
what are the common locations of lacunar stroke ?
internal capsule
thalamus
basal ganglia
pons
what vessels are most commonly associated with lacunar strokes ?
the lenticulostriate branches of the MCA
anterior choroidal artery of the ICA
what are charcot bouchard microaneurysms ?
microaneurysms that form in the lenticulostriate vessels
