Clinical Stroke Syndrome Flashcards
(27 cards)
Understanding clinical syndromes associated with defined cerbrovascular lesions in ischemic stroke can?
Valuable too in rehab
The anatomic distribution of the Middle Cerebral Artery include?
Large proportion of cerebral cortex and ischemia within MCA imparts significant impairment and disability, requiring rehab
MCA is particularly vulnerable to?
Cardioembolic and thromboembolic diseases
Impairments after occlusion of the MCA main stem (M1 segment) include?
Contralateral hemiplegia Contralateral hemianesthesia Contralateral hemianopsia Head or eye turning toward lesion Dysphagia Uninhibited neurogenic bladder DOMINANT HEMISPHERE global aphasia, apraxia NONDOMINANT HEMISPHERE aprosody and affective agnosia, visuospatial deficit, neglect syndrome
Hemiplegia in a main stem stroke is?
Complete, affecting upper and lower limbs and lower portions of face equally.
Results primarily from? Main stem mca
Ischemia from within the deep lenticulostriate circulation to posterior limb of the internal capsule through which descending fibers of primary motor cortex pass.
Sensory deficits can be significant because?
Ascending sensory fibers are injured as well, but deep pain sensation can be intact.
mcA perforators supply only what part of visual radiations? Thus?
Upper half of visual radiations, but complete hemianospsia is frequently described.
Anterior circulation- brain consists of?
Both internal carotid derived from the right and left common carotid arteries.
Right carotid is usually a branch of the right subclavian, the left is a direct branch of the aorta.
After internal carotid passes intracranially towards the carotid siphon?
It provides the ophthalmic branch to the orbit andforms anastomosis of the circle of Wilis with the ipsilateral posterior communicating artery.
The internal carotid then bifurcates into?
Anterior cerebral artery (aca) and mca.
MCA STEM or M1 segments turn laterall, passing along?
The base of the brain to Sylvian fissure overlying the insular cortex, where it typically bifurcates into upper and lower division.
Along path of M1 segment, small, deep, perforating branches called lenticulostriate arteries are supplied to?
Putamen, globus pallidus, caudate and internal capsule
M2 segment comprises?
Upper and lower divisions of the MCA as they travel posteriorly and superiorly along the insular cortex.
MCA upper divison stokes?
Contralateal hemiplegia Contralateral hemianesthesia Contralateral hemianopsia Head or eye turning toward lesion Dysphagia Uninhibited neurogenic bladder DOMINANT HEMISPHERE broca aphasia Apraxia NONDOMINANT HEMISPHERE aprosody Visuospatial deficit neglect syndrome
In mca upper divison, Clinical presentation is very similar to that of mainstem infarction, but?
Hemiplegia and language comprehension deficits are usually not as severe.
In upper divison, Because m1 segment of mca is spared, vascular supply to internal capsule is?
Preserved, ischemia is limited to the inferolateral portion of the primary motor cortex. As a result motor strength and control ar e better in lower limb than in hand and face.
Anatomic location of lesions within the cns predicts?
Physical or cognitive impairment and disability
A classic broca type aphasia is typical in? Upper div
A dominant hemisphere stroke, and aprosodia without affective agnosia is founf in nondominant hemisphere stroke
Branch obstruction of the mca lower division is?
Motor sensory function?
Much less common than upper division stroke and usually caused by embolic event.
Generally intact
Stroke of mca lower division can still have?
Significant functional disability from impaired language and vision, poor awareness of deficits.
Middle carabral artery stroke: lower division
Contralateral homonymous hemianopsia dominant hemisphere - wernicke aphasia Nondominant hemisphere - affective agnosia
Wernicke’s aphasia?
sensory aphasia, is a type of aphasia in which people with the condition are unable to understand language in its written or spoken form, and even though they can speak with normal grammar, syntax, rate, and intonation, they cannot express themselves meaningfully using language.
Broca’s aphasia
Expressive aphasia (non-fluent aphasia) is characterized by the loss of the ability to produce language (spoken or written).
Expressive aphasia is also known as Broca’s aphasia in clinical neuropsychology and agrammatic aphasia in cognitive neuropsychology and is caused by acquired damage to the anterior regions of the brain, including (but not limited to) the left posterior inferior frontal gyrus or inferior frontal operculum, also described as Broca’s area (Brodmann area 44 and Brodmann area 45)[2]
