Stroke

Question 1

What would indicate an ACA stroke

Answer 1

• Leg weakness (more likely than arm weakness since more of leg in ACA
• Sensory disturbances in the legs
• Gait apraxia (loss of ability to have normal function of the lower limbs such as walking)
• Truncal ataxia - patients can’t sit or stand unsupported and tend to fall backwards
• Incontinence
• Drowsiness - since part of consciousness is in the frontal lobe (which the ACA supplies)
• Akinetic mutism: Decrease in spontaneous speech. Stuporous state

Question 2

What would indicate an MCA stroke

Answer 2

• CONTRALATERAL ARM & LEG WEAKNESS
• CONTRALATERAL sensory loss
• homonymous Hemianopia
• Aphasia (inability to understand or produce speech)
• Dysphasia (deficiency in speech generation)
• Facial droop

Question 3

What would indicate an PCA stroke

Answer 3

• CONTRALATERAL HOMONYMOUS HEMIANOPIA (loss of half the vision of the same side in both eyes
• Cortical blindness (eye healthy, but brain issue causing blindness)
• Visual agnosia - cannot interpret visual information, but can see
• Prosopagnosia - cannot see faces
• Colour naming and discriminate problems
• Unilateral headache - RARE in ischaemic stroke, so if you see headache then think PCA

Question 4

What would indicate a posterior circulation territory stroke (vertebrobasilar artery)

Answer 4

• MORE CATASTROPHIC due to wide region supplied
• Likely to get ‘locked in’ in these strokes
• Motor deficits such as hemiparesis or tetraparesis and facial paralysis
• Dysarthria (unclear speech articulation) & speech impairment
• Vertigo, nausea & vomiting
• Visual disturbance
• Altered consciousness

Question 5

What would indicate a lacunar stroke

Answer 5

• Unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three
• Pure sensory loss
• Ataxic hemiparesis (cerebellar and motor symptoms)
• In general only 1 modality tends to be affected

Question 6

What is indicative of total anterior circulation syndrome

Answer 6

(large cortical stroke in MCA/ACA) all 3 of:
contralateral weakness of face, arm and legs
homonymous hemianopia
higher dysfunction (dysphagia, visuospatal disorder)

Question 7

What is indicative of partial anterior circulation infarct syndrome

Answer 7

(cortical stroke in ACA/MCA) 2 of:
contralateral weakness +/or sensory deficit of face, arm and legs
homonymous hemianopia
higher dysfunction (dysphagia, visuospatal disorder)