Stroke Flashcards by Sterben 004

Ninja Nerd

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The middle cerebral artery supplies what are of the cerebral cortex( In terms of primary motor function)

The part that contros the Face and arms

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The anterior cerebral artery supplies what are of the cerebral cortex( In terms of primary motor function)

The part that controls the leg

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Which blood vessels supply the anterior part of the brain?

Anterior cerebral artery
Internal carotid
Middle cerebral artery

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Which blood vessels supply the posterior part of the brain?

Posterior cerebral artery
Basillar artery
Vetebral artery

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Which parts of the brain does the posterior artery supply?

The occipital lobe
Thelamus
Mid brain
Parts of temporal

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Which parts of the brain does the basillar artery supply?

Pons
Superior anterior nd inferior part of the cerebellum

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Which parts of the brain does the vertebral artery supply?

Medulla and
Posterior and inferior aspects of the cerebellum

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Whats the difference between trans ischemic stroke and acute ischemic stroke

TIS:Neural defesite without evidence of infarction bt CT or MRI & lasts less than 24hrs

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Causes ot TIS

Hypoxic(Cardiac arrest, shock ( speric or cardiogenic), respiratory failure)
- Thrombotic
Due to plaque
Hypertension
Diabetes
Smoking
Obesity
Dyslipedemia
- Embotic
atrial fibrillation,
Left ventricular aneurysm
Mechanical heart valve
Paradoxical embolism ( DVT & patent FORAMRN OVALE)

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Intra cerebral hemorrhage causes

Intra cerebral hemorrhage can be classified into? What are the difference

Hypertension
Coagulopathy
Malignancy
Trauma

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Hypertension intra cerebral hemorrhage usually occur at

Bassl ganglia
Pons
Cerebellum

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Sub arachnoid hemorrhage usually occur due to?

Poped aneurysm

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What is the most common type of aneurysm that will rupture?

Berry/Saccular aneurysm

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Intra cerebral hemorrhage causes accumulation of blood in?

The parenchyma of the brain

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Rupture in the ACA causes what neuro deposit

Contralateral weakness of the lower limb than the upper limb& face

Contralateral lose of sensation in the lower limb than face and upper limbs

Prefrontal cortex deficit
Bullia: decrease motivation and desire to participate in certain activities

Akinetic mutism: is a medical condition where patients tend neither to move nor speak.

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Rupture in the MCA causes what neuro deposit

Contralatera motorl weakness of the face and upper limb more than lower limb

Contralateral sensory weakness of the face and upper limb more than lower limb

Difficulty with skilled movements even when a person has the ability and desire to do them.

Frontal eye field
If the left side MCA is clotted it will cause gaze deviation to that same side ( ipsilateral gaze deviation)
Brocas area (@ Left side hemisphere of Parietal)
Brocas aphasia
Warinke (@ Left hemisphere of temporal)
Werinke aphasia
Temporal & parietal lobe( is the ath optic N follow)
Damage to the optic radiation causing contral lateral loss in the visual field. homonymous hemianopia, is a visual field loss in the same halves of the visual field of each eye. For example, in right HH, the visual field loss is on the right side in the right eye and on the right side in the left eye

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Note: In an ICA occlusion you might have symptoms of both MCA & ACA because ICA is the main branch that later forms the two

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Whats the special feature of ICA occlusion that will que. Other than the MCA and ACA features that will present

Opthlamic nerve damage ( causing temporary Mono occular vision loss amaurosis fugax

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Whats watershed syndrome & what can cause it?

Hypovolumia
A watershed strokeoccurs when the blood flow to parts of the brain, known as border zones, is severely reduced, leading to brain tissue death. The border zones are vulnerable because they are situated furthest away from the three major arteries that service the brain.

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What are the conditions that can occur in MCA/ACA watershed zone damage?

Proximal upper and lower thrunk loss of sensation

Man in a barrel syndrome isa neurological syndrome involving bilateral upper extremity weakness with preserved facial and lower extremity strength.

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What are the conditions that can occur in MCA/PCA watershed zone damage?

Prosopagnosia also known as face blindness, is a cognitive disorder of face perception in which the ability to recognize familiar faces, including one’s own face, is impaired, while other aspects of visual processing and intellectual functioning remain intact

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Rupture in the PCA causes what neuro deposit

visual field
Contralateral visual loss ( contralateral homonus Heminopia)
Inability to read Alsxia without agraphia
Thalamus
Contralateral loss of sensation and pain
Mid brain
Benedict syndrome: Benedikt syndrome (paramedian midbrain syndrome) is characterised by varying levels of ipsilateral third cranial nerve palsy, hemiparesis, and contralateral tremor.

Webber syndrome:
Claude’s syndrome

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Lacuna infarcts are a subset of MCA occlusion (it involves sma branches from the MCA)
The Lacuna infarction can cause?

Contralateral
Pure motor
Pure sensory
Sensor motor
Ataxiis hemipheisis
Disathrial clumsy hand syndrome

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Rupture in the Basilar causes what neuro deposit

Ippsilateral 6th N palsy (Abducent N) Corticospinal tract ( contro lateral weakness) Medial meniscus ( contro lateral loss of touch and vibration

The basilar artery give off what major artery?

AICA Superior C Artery

Damage to the AICA can cause?

5th (weakness in mastication muscles on the same side) & 7th N palsy ( facial weakness on the same side) - Cochlear N damage (Deafness) Vestibular N( nausea, vomiting, loss of balance) - Trigeminal tract damage - Defending Sympathetic tracts ( Anhydrousis, miosis, ptosis)

Superior CA

Ataxia Dysmetria

Damage to the vertebral can cause?

The tongue deviates to the same side ( hypoglosial N) Contralateral muscle weakness ( corticospinal) Contralateral sensory loss

Features of ICH & SAH

ICH Headache Increase ICP SAH Thunderclap headaches Meningitis signs Increased ICP

The gold standard to check for the location of sub arachnoid hemorrhage is

Digital subtraction angiogram

In transient ischemic attack how do you managed it using risk calculation

A- >60 year old B- >140/90 C- >clinical features (Aphasia= 1, any other defisite= +2 D- >60 = +2, <60 min = +1 DM- >+1

Treatment of AIS?

TPA : For <3 hrs of normal activity Thromdectomy >6 hr of normal activities An IV injection of recombinant tissue plasminogen activator (TPA) is the gold standard treatment for ischemic stroke. Its primary function includes catalyzing the conversion of plasminogen to plasmin, the primary enzyme involved in dissolving blood clots.

*VIDEO*

Note: in a patient with worsening clinical features of stroke per hr it should be directly considered a Acute Ischemic Attack/Stroke even if the brain scan is looking normal

How do you manage a TIA?

Dual anti platelets therapy **DAPT** Aspirin & Clopidogrel Clopidogrel is **an antiplatelet medicine**. It prevents platelets (a type of blood cell) from sticking together and forming a dangerous blood clot If atrial defeibulation is present + then add Noble oral anti coagulant

In managing a stroke pt. In emergency you do?

A B C Glucose = too high = swelling in the brain, too low = neurons won't be able to handle the stress NICE Head

A right hand man with a dominant side parietal lobe ischemia will cause?

Mathematics defisites/ **Acalculia** Understanding written text defisites/ **Agraphia** Loss of L& R orientation/ **Finger agnosia** Speech imparement

Damage to the dominant parietal lobe causes a syndrome called?

Gerstmann syndrome

What are the features of Gerstmann syndrome

Acalculia Agraphia L&R disorientation/ Finger Agnosia Speech imparement

A right hand man with a non dominant side parietal lobe ischemia will cause?

Visual spacial skill loss/ Constructional Apraxia Hemi Neglect Anoso Agnosia/ inability to appreciate severity ( 😊 ungrateful fuck)

Clock face test is done to confirm?

Constructional Apraxia

If someone is eating from a plate and only eats one side without touching the other it's a sign of? Or shaving only one side of your face

Hemi neglect

Temporal lobe ischemia will affect?

Hippocampus/ short term memory/**Antegrade Amnesia** Can't remember faces/ **Prosoagnodia**( damaged at the junction btw temporal and occipital lobe) Complex Hallucinations Deja Vu/ undue familiarity Jamai Vu/ u familiarity

Long term memory is stored at?

Neo cortex

Pure word deafness is a sign of damage to?

Sup. Temporal gyrus (warinke)

Pure word blindness is a sign of damage to?

Left occipital lobe or Splenium

Frontal lobe ischemia will affect?

Change in personality Anti social behavior Uncontrolled urination Apathy **Abulia** lack of desire to speak Primitive reflexes ( e.g grasp reflexes, Rooting reflexes, **Note: Moro Reflexes never reappear no matter what**) Loss of Programmed gaite( Magnetic Gait or gait Apraxia)

Which part of the brain control urination

Paracietal lobule

Constructional Apraxia and gait Apraxia is as a result of damage to what vessel & affects what part of the brain?

Constructional = Dominant parietal lobe & MCA Gait = frontal lobe & ACA

Occipital lobe ischemia will affect? PCA damage

Visual Hallucinations Palinopsia: persistent of images even when the image has been removed Asimultagnosia: : can't identify two objects at the same time Homonymus heminopia Gun barrel vision

What's cortical blindness?

What's anton syndrome & which blood vessels is damage to cause it?

Anton Syndrome is **a manifestation of bilateral occipital lobe damage in cortically blind patients**. These patients lack insight into their disease and deny their blindness. Bilateral distal PCA

Damage to what blood vessels can cause paraplegia

ACA

Brocas area is supplied by?

Sup. Division of MCA

LMCA Lesions can result in DMCA "" "" ""

LMCA = APHAsIA DMCA = APRAXIA

Lacunar stroke can occur due to?

Athtosclerosis/**Lipohyalinosis of smaller blood vessels

Berry aneurysm location & rupture is common @

Anterior communicating Artery

Between A1 and A2 circulation in the circle of lewis which is tolerable to ischemia due to collateral flow & which isn't?

A1 is tolerable & A2 isn't

The basilar artery gives off the posterior cerebellar artery which he a P1 & P2 section The P1 section supplies & the P2 section supplies? Vertebral artery lesions causes Pontine stroke can be caused by lesion to what artery? And the lesions will cause?

P1= mid brain ( mid brain stroke) P2= occipital cortex ( visual hallucinations) / Medullary stroke. Basilar artery

What is the nerve that can be compressed in an un ruptured or rupturedPst communication artery Berry aneurysm

3rd cranial N causing (ptosis, squint)

Which blood vessels is affected in mrdial medullary syndrome

Anterior spinal artery

Which blood vessels is affected in lateral medullary syndrome

**Vertebral artery** or Posterior inferior cerebellar artery

Which nerves are Functions are impaired in collusion to Post. Inferior cerebellar artery PICA

5,7,8,9,10,11

Which nerves are Functions are impaired in collusion to Ant. Spinal artery

12th N

Which nerves are Functions are impaired in collusion to Ant. Inferior cerebellar artery AICA

7,8

What's Horner syndrome Blockage to which blood vessels can cause Horner syndrome

Horner syndrome? Introduction. Horner syndrome is a rare condition classically presenting with partial ptosis (drooping or falling of upper eyelid), miosis (constricted pupil), and facial anhidrosis (loss of sweating) due to a disruption in the sympathetic nerve supply. PICA and Superior Cerebellar Artery

Which cerebral artery doesn't participate in the circle of Willis?

MCA

What's Total anterior circulation stroke The blood vessels involved and its features

ACA+MCA Unilateral weakness (and/or sensory deficit) of the face, arm and leg. High Cerebral malfunction Homonymous hemianopia

Which cranial nerve has a crossed origin?

CN4 Muscle of the right eye is supplied by the left and vise visa

Which N is the longest?

Vagus N

Which nerve has the longest intra cranial route?

Trochlear N

Which cranial nerve has a dorsal origin? Note all other originte from ventral root

Trochlear N

Which nerve is the thickest and the thinnest

Thickest= Trigeminal N Thinnest= 4th N

Substanria Niagara lesion=

Parkinson's dxs