Norden - Stroke

Question 1

A small infarcted area, it may occur from occlusion of a small end artery

Answer 1

Lacunar infarct

Question 2

Occurs between the distribution of two major arteries

Answer 2

Watershed infarct

Question 3

Insufficiency of blood supply to some area of the brain

Answer 3

Stroke

Question 4

Stroke where the vessel ruptures and bleeds. Accounts for 10-15% of strokes.
Herniation is possibility

Answer 4

Hemorrhagic stroke

Question 5

Area of tissue death

Answer 5

Necrosis

Question 6

Area of necrosis in the brain

Answer 6

Infarction

Question 7

an absence of willpower or an inability to act decisively, as a symptom of mental illness.

Answer 7

Abulia (seen in ACA stroke) [will also be seen in ALZ]

Question 8

medical term describing patients tending neither to move (akinesia) nor speak (mutism).

Answer 8

Akinetic mutism (seen in ACA stroke)

Question 9

A tia involving the opthalmic artery that produces a temporary or transient ipsilateral blindness

Answer 9

Amaurosis fugax

Question 10

What is a small vessel stroke?

Answer 10

Stroke of branches that supply deep structures in the hemispheres.

Question 11

PCA; basal):
•Contra spastic paresis/paralysis (body below the neck) with a Babinski; contra lower facial paresis/paralysis
•Ipsi oculomotor ophthalmoplegi

Answer 11

Weber’s Syndrome

Question 12

ontra tremor upper limb and ipsi oculomotor ophthalmoplegia

Answer 12

Claude’s Syndrome (PCA OR BASILAR; tegmental)

Question 13

Weber’s and Claude’s Syndrome

Answer 13

Benedikt’s syndrome (basilar)

Question 14

A “brain attack” brought about by an acute impairment of CNS blood supply

Answer 14

Stroke

Question 15

Why are hemorrhagic strokes especially dangerous/

Answer 15

The hemorrhage and resulting clot take up space in the brain and can lead to herniation and death

Question 16

Rf’s for hemorrhagic stroke

Answer 16

HTN
Atherosclerosis
Diabetes
Other systemic and chronic disorders

Question 17

A vessel is occluded by plaque, constituents of blood, or foreign matter. Account for about 85% of all strokes

Answer 17

Ischemic stroke

Question 18

Most ischemic strokes are __

Answer 18

Thrombotic

Question 19

Neurons which undergo anoxia and infarction take on which staining pattern ?

Answer 19

Dead reds (pathognomonic for ischemic stroke)

Question 20

Acute, transient neurological episode caused by ischemia which normally returns to normal w/in 30 minutes.

Answer 20

TIA

Question 21

___% of people w/ TIA’s ill go on to have a major stroke w/in 3 years.

Answer 21

80

Question 22

Ischemic strokes can set off a _____ _____ which is when excess amounts of glutamate are released and accumulated in the interstitial space and leads to the influx of calcium which in term damages neurons that weren’t originally damage from the ischemia

Answer 22

Excitotoxic cascade

Question 23

What type of edema can an ischemic stroke lead to ?

Answer 23

Cytotoxic edema ( from excitotoxic cascade )

Question 24

Cortical strokes are ___ vessel strokes

Answer 24

Large vessel

Question 25

Sudden transient loss of vision on one side resulting from occlusion of the central retinal artery

Answer 25

Amaurosis fugax

Question 26

Global aphasia Ipsilateral visual loss Contralateral spastic paralysis w/ babinski Loss of contralateral fine touch, vibration, conscious proprioception Paralysis of lower face (UMN of VII)

Answer 26

Stroke of ICA

Question 27

What stroke causes: Contralateral; spastic paralysis/paresis w/ Babinski, loss of fine touch, vibration, and conscious proprioception, loss of ability to localize pain, lower face paralysis

Answer 27

Lenticulostriate stroke | Knocks out genu and posterior limb of internal capsule

Question 28

Strokes within the brainstem never present with?

Answer 28

Visual field defects or with cortical signs

Question 29

What are the 3 major stroke syndromes that occur in the midbrain at the level of the superior colliculus?

Answer 29

Weber’s syndrome Benedikt’s syndrome Claude’s Syndrome

Question 30

What is the most common cause of Weber’s Syndrome?

Answer 30

Stroke of the penetrating branches of the PCA

Question 31

What are the symptoms of weber syndrome and what causes it?

Answer 31

Contralateral: paralysis/paresis of body below neck, with a babinski Contralateral: lower face paralysis / paraesis Ipsilateral: Occulomotor opthalmoplegia

Question 32

What happens in Claude’s Syndrome

Answer 32

A stroke involving small branches of either the PCA or basilar that supply only the midbrain tegmentum; signs/symptoms will include contralateral tremor (primarily of upper limb; from involvement of the red nucleus) and ipsilateral oculomotor ophthalmoplegia

Question 33

Describe what happens in Benedikt’s syndrome

Answer 33

Results most commonly from strokes involving penetrating branches of the basilar artery; involves the basal and tegmental areas of the midbrain; signs/symptoms are a combination of Weber’s and Claude’s syndromes

Question 34

a patient may show ipsilateral sensory loss in the face (Why? What reflex or reflexes might you test – and what would you expect to see?) and contralateral loss of fine touch, vibration, proprioception and pain sensation (of the body below the neck; Why?)

Answer 34

Tegmentum of rostral pons

Question 35

What stroke syndrome will have a contralateral paralysis/paresis with a babinski (body below neck) and spastic paralysis of lower face ``

Answer 35

Stroke of rostral basal pons

Question 36

What symptoms does a stroke in the caudal pons tegmentum have ?

Answer 36

It will involve facial colliculus, so ipsilateral paralysis/paresis of entire side of face. Ipsilateral medial strabismus.

Question 37

A bilateral syndrome of the basal pons which can occur 2nd to a stroke involving basilar artery. Pt appears to be in coma but is not comatose. Pt is awake and alert, but entirely paralyzed except for vertical eye movement and sometimes eyelid movement

Answer 37

Locked-in syndrome

Question 38

What are the only movements that are intact in locked in syndrome ?

Answer 38

Vertical eye movements and Sometimes eyelid movement

Question 39

Strokes involving the upper part of the basilar where it divides into the two PCA arteries can result in ?

Answer 39

Significant memory impairment

Question 40

Locked-in syndrome is due to bilateral basal pons damage following a stroke involving

Answer 40

The basilar artery

Question 41

Strokes involving the medulla are?

Answer 41

Medial medullary syndrome Wallenberg’s syndrome

Question 42

The artery involved in Wallenberg’s syndrome (lateral medullary syndrome )

Answer 42

PICA | Supplies the dorsolateral medulla

Question 43

Wallenberg’s syndrome (also called the lateral medullary syndrome or PICA syndrome): occurs from strokes involving branches of the posterior inferior cerebellar artery (PICA), which supplies the dorsolateral area of the medulla; because of the areas supplied (Fig. 8), the patient presents with a characteristic constellation of signs/symptoms including:

Answer 43

1) Contralateral signs/symptoms: Loss of pain and temperature in the body below the neck (because of involvement of the lateral spinothalamic tract which carries pain and temperature information (Why is the loss contralateral?); Note the importance of knowing where and when pathways cross or decussate as they ascend in the brainstem! 2) Ipsilateral/other signs/symptoms: Loss of pain and temperature in the face (Why?); vertigo, nystagmus, nausea and vomiting (from involvement of vestibular nuclei), ataxia (from involvement of the inferior cerebellar © 2017 Jeanette J. Norden per Legacy Law Group, Nashville, TN Norden, Jeanette J. peduncle), and a Horner’s syndrome (consisting of the triad of miosis [pupillary constriction], ptosis [lid droop], and anhydrosis [decreased sweating of the face]) because of the involvement of sympathetic fibers which course through this area of the medulla; a weak or absent gag reflex, dysphonia (difficulty speaking; voice may be hoarse) dyspnea (difficulty breathing) and dysphagia (difficulty swallowing) - all due to involvement of the nucleus ambiguus

Question 44

What artery causes medial medullary syndrome ?

Answer 44

Middle medullary artery (branch of vertebral)

Question 45

What is hit in middle medullary syndrome ?

Answer 45

Medial lemniscus Pyramid LMN of XII

Question 46

What symptoms arise in medial medullary syndrome ?

Answer 46

Tongue deviation towards side of lesion Loss of contralateral fine touch, proprioception, and vibration, below level of lesion. Contralateral spastic paralysis below the level of the lesion, with a babinski.