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Flashcards in FN: Stroke Presentation Deck (15):
1

Total Anterior Circulation Stroke:

• Infarct in carotid/MCA, ACA territory

2

Total Anterior Circulation Stroke: presentation

2. Hemiparesis (contralateral) and/or sensory deficit (>2 + of face, arm and leg)
3. Homoymous hemianopia (contralateral)
4. Higher cortical dysfunction
a. Dominant L usually: dysphasia
b. Non-dominant: hemispatial neglect

3

Posterior Circulation Stroke (POCS)

→ Infarct in vertebrobasilar territory

4

Posterior Circulation Stroke (POCS) presentation any of:

1. Cerebellar syndrome
2. Brainstem syndrome
3. Contralateral homonymous hemianopia

• LAterla Medullary syndrome
• Millard-Gubler syndrome
• Locked-in Syndrome

5

Partial Anterior Circulation Stroke (deficit less dense and/or incomplete).

• Infarct in carotid/MCA and ACA territory

6

Partial Anterior Circulation Stroke (deficit less dense and/or incomplete).
Presentation: 2/3 of TACS criteria

1. Hemiparesis (contralateral) and/or sensory deficit (>2 + of face, arm and leg)
2. Higher cortical dysfunction
a. Dominant L usually: dysphasia
b. Non-dominant: neglect, constructional apraxia

7

Lacunar Stroke (LACS)

→ Small infarcts around basal ganglia, internal capsule, thalamus and pons

8

LACS Absence of

• Higher cortical dysfunction
• Homonymous hemianopia
• Drowsiness
• Brainstem signs

9

Lacunar 5 syndromes

• Pure motor: post. Limb of internal capsule – commonest
• Pure sensory: post. Thalamus (VPL)
• Mixed sensorimotor: internal capsule
• Dysarthria/clumsy hand
• Ataxic hemiparesis: ant. Limb of internal capsule – weakness + dysmetria

10

LAteral Medullary Syndrome/Wallenbergs syndrome

PICA or vertebral artery

11

LAteral Medullary Syndrome/Wallenbergs syndrome features

DANVAH
Dysphagia
Ataxia (ipsilateral)
Nystagmus (ipsilateral)
Vertigo
Anaesthesia:
1. Ipsilat facial numbness + absent corneal reflex
2. Contralaterl pain loss

Horner's syndrome

12

Millard-Gubler Syndrome

Pontine infarct
6th and 7th CN nuclei+ corticospinal tracts
1. Diplopia
2. LMN facial palsy + loss of corneal reflex
3. Contralateral hemiplegia

13

Locked in syndrome

Pt. is aware and cognitively intact but completely paralysed except for the eye muscles

14

Locked in syndrome causes

Ventral pons infarction: basilar artery
Central pontine myelinolysis: rapid correction of hyponatraemia

15

Stroke differential

Head injury ± haemorrhage
High or low glucose
SOL
Hemiplegic migraine
Todd's palsy
Infections: encephalitis, abscessess, Toxo, HIV, HTLV
Drugs: e.g. opiate overdose

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