Stroke Flashcards
Which vessel(s) can be occluded in an anterior circulation stroke?
- Internal carotid artery
- Middle cerebral artery
- Anterior cerebral artery
What is the criteria for a total anterior circulation stroke?
- Motor or sensory deficits (contralateral) in 2 out of 3 of the face, arm, and legs
- Impaired higher function, apraxia, agnosia, hemispatial neglect, altered consciousness
- Visual field changes, esp homonymous hemianopia
What is the criteria for a partial anterior circulation stroke?
2 out of 3 of:
- Motor or sensory deficits (contralateral) in 2 out of 3 of the face, arm, and legs
- Impaired higher function, apraxia, agnosia, hemispatial neglect, altered consciousness
- Visual field changes, esp homonymous hemianopia
Which vessel(s) can be occluded in a posterior circulation stroke?
Vertebral-basilar system or posterior cerebral artery
What are the features of a posterior circulation stroke, generally?
- CNS palsy plus contralateral motor/sensory deficits of the body
- Eye movement problems
- Isolated homonymous hemianopia
- Cerebellar lesions
What are the features of an anterior cerebral artery stroke?
- Contralateral hemiparesis and sensory loss
- Lower extremity more severely affected than upper extremity
What are the features of an middle cerebral artery stroke?
- Contralateral hemiparesis and sensory loss
- Upper extremity more severely affected than lower extremity
- Contralateral homonymous hemianopia
- Aphasia
What are the features of an posterior cerebral artery stroke?
- Contralateral homonymous hemianopia with macular sparing
- Visual agnosia
Which vessel is occluded in locked-in-syndrome?
Basilar artery
What are the features of locked-in-syndrome?
Complete paralysis of voluntary muscles in all parts of the body
Eye muscles and sometimes the big toe may be spared
Which vessel is occluded in lateral medullary syndrome/Wallenberg syndrome?
Posterior inferior cerebellar artery
What are the features of lateral medullary syndrome/Wallenberg syndrome?
- Cerebellar features (ataxia, nystagmus)
- Ipsilateral face signs (Horner’s, loss of temperature and pain sensation, dysarthria, dysphagia
- Contralateral body signs (loss of temperature and pain sensation)
Which vessel is occluded in median medullary syndrome/Dejerine syndrome?
Paramedian branches of the anterior spinal artery
What are the features of medial medullary syndrome/Dejerine syndrome?
- Contralateral paralysis of the upper and lower limb
- Contralateral decrease in proprioception, vibration, and/or fine touch sensation
- Ipsilateral deviation of the tongue
- Dysphagia
- May present with vertigo, nausea, and contralateral limb ataxia
Which vessel is occluded in lateral pontine syndrome/Marie-Foix syndrome?
Anterior inferior cerebellar artery
What are the features of lateral pontine syndrome/Marie-Foix syndrome?
- Ipsilateral limb ataxia
- Ipsilateral loss of pain and temperature sensation of the face
- Ipsilateral facial weakness
- Ipsilateral hearing loss, vertigo, and nystagmus
- Contralateral hemiplegia/hemiparesis
- Contralateral loss of pain and temperature sensation
Which vessel is occluded in medial inferior pontine syndrome/Foville syndrome?
Paramedian branches of the basilar artery
What are the features of medial inferior pontine syndrome/Foville syndrome?
- Gaze palsy to the side of the lesion
- Ipsilateral abducens and facial nerve palsy
- Contralateral hemiplegia
Which vessel is occluded in midbrain/Weber’s syndrome?
Branches of the posterior cerebral artery
What are the features of midbrain/Weber’s syndrome?
- Ipsilateral surgical CN III palsy (diplopia, ptosis, RAPD)
- Contralateral hemiplegia/hemiparesis
- Contralateral parkinsonian rigidity
Which vessel(s) is occluded in lacunar stroke?
- Lenticulostriate
- Thalamoperforating
- Pontine perforating
What are the features of lacunar stroke?
- Unilateral motor and/or sensory deficits
- Ataxic hemiparesis: ipsilateral clumsiness ans weakness, as opposed to cerebellar dysfunction
- Dysarthria and clumsy hand
What is first-line imaging in a suspected stroke?
Non-contrast CT head
What is the ROSIER score?
ROSIER = Risk Of Stroke In the Emergency Room
- Score >0 means that a stroke is likely
- LOC or syncope: -1 point
- Seizure activity: -1 point
- Acute asymmetric facial weakness: +1 point
- Acute asymmetric arm weakness: +1 point
- Acute asymmetric leg weakness: +1 point
- Speech disturbance: +1 point
- Visual field defect: +1 point
