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Flashcards in Stroke Syndromes Deck (33):
0

Hemorrhagic Stroke

Rupture of an aneurysm (Anterior communicating arteries)

-Produces crescent shaped CT image

-Will see severe headache, nuchal rigidity, and decreased consciousness

1

Ischemic Stroke

Occlusion of a blood vessel; more common than hemorrhagic

*Thrombotic are most common

2

Lacunar infarct

Small infarcted area due to occlusion of small end artery

3

Watershed infarct

Occurs b/w distribution of two mjor arterie

4

TIA

Transient Ischemic Attack

Normal fnxn returns in 30mins-24hrs

*Assoc. w/ increased risk for stroke; possibly within hours

5

Ischemic cascade

Death of neuronal cells causes excess release of glutamate

=>Ca2+ into other cells causing their death as well

6

Pnumbra

Area surrounding center of infarction in which damage is not yet irreversible

7

Lesion of optic chiasm

Produces a bitemporal hemianopsia

8

Lesion central to optic chiasm

Produces homonymous hemianopsia

-(Optic tracct, lateral geniculate nucleus of thalamus, Area 17)

9

ICA Stroke

-May have amaurosis fugax due to occlusion of CRA

-Global aphasia

-Eye deviation to side of lesion

-Tongue deviation away from lesion

Contralateral:
Spastic paralysis w/ Babinski (Primary Motor Cortex)
Paralysis of lower face (UMNs of VII)
Loss of fine touch, vibration, conscious proprioception (SI)
-Pt. cannot localize pain either

Ipsilateral:
Vision loss

10

MCA stroke

-Global aphasia if on left

Contralateral:
Spastic paralysis (Lateral part of Area 4)
Loss of fine touch, vibration, conscious proprioception (Lateral part of Areas, 3,1,2)
No pain localization (Lateral part of Areas 3,1,2)
*All upper body > lower body

Ipsilateral:
Eye deviation towards lesion
Tongue deviation away from lesion
Neglect
`

11

ACA stroke

-Abulia, akinetic mutism, urinary incontinence

Contralateral:
Spastic paralysis w/ Babinski (Medial part of Area 4)
Loss of fine touch, vibration, conscious proprioception (Medial Areas 3,1,2)
No localization of pain (Medial Areas 3,1,2)

*Upper body > Lower body

12

PCA stroke

-Contralateral homonymous hemianopsia w/ macular sparing

-Memory deficits
*Due to damaged hippocampus

13

Abulia

Loss of ability to act voluntarily

14

Akinetic mutism

Decreased thought, movement, speech, emotion

15

Amaurosis fugax

Sudden transient loss of vision on one side due to occlusion of CRA

-TIA symptom

16

Stroke of lenticulo-striate branches

Supply genu and posterior limb of internal capsule (subcortical area)

Contralateral:
Spastic paralysis w/ Babinski
Loss of fine touch, vibration, conscious proprioception
No ability to localize pain
Lower facial paralysis

*damaged corticobulbar and corticospinal axons

*will not see any cortical signs

17

Thalamic strokes

-Involve penetrating branches of PCA

-Symptoms assoc. w/ branches involved

-Produces thalamic syndrome if VPL is involved

18

Weber's Syndrome

Stroke of penetrating branches of PCA

-Affects basal area

Contralateral:
Spastic paralysis w/ Babinski (PLIC)
Lower facial paralysis

Ipsilateral:
Oculomotor opthalmoplegia

19

Oculomotor opthalmoplegia

Damage to CN III

1.Lateral strabismus
2. Ptosis
3. Pupil dilation

20

Claude's Syndrome

Stroke of PCA or basilar artery

-Affect tegmentum of midbrain

Contralateral:
Tremor (Red nucleus)

Ipsilateral:
(Oculomotor opthalmoplegia

21

Benedikt's Syndrome

-Stroke of penetrating branches of basilar artery

-Involves basal and tegmental areas => combination of Weber's and Claude's syndromes

22

Rostral pons strokes (Basal)

-Pontine arteries

Contralateral:
Spastic paralyis w/ Babinski (corticospinal axons)
Lower face paralysis (corticobulbar axons)

23

Rostral pons stroke (Tegmentum)

-Pontine arteries

Contralateral:
Loss of fine touch, vibration, conscious proprioception (Medial lemniscus)

Ipsilateral:
Facial sensory loss (V axons)

*Corneal reflex in ipsilateral side would be lost

24

Caudal pons stroke (Basal)

-Pontine arteries

Contralateral:
Spastic paralysis w/ Babinski (corticospinal axons)
Lower face paralysis (possible; could also be total ipsilateral)

25

Caudal Pons Stroke (Tegmentum)

-Pontine arteries

Ipsilateral:
Facial paralysis (VII nucleus/axons)
Medial strabismus (VI nucleus/axons)

*Could be many other symptoms (medial lemniscus) but these 2 are DIAGNOSTIC

26

Locked-in syndrome

Bilateral syndrome of basal pons occurring after basilar artery stroke

-Entirely paralyzed except for vertical eye movement
(Vertical gaze center found in PAG)

*Pt not in full coma because RAS is intact

27

Wallenburg's Syndrome

(Lateral medullary syndrome)

(PICA syndrome)

-Stroke involving branches of PICA

Contralateral:
Loss of pain and temp. sensation (Lateral spinothalamics)

Ipsilateral:
Loss of pain and temp. in face (Spinal tract/nucleus of V)
Vertigo, nystagmus, nausea, vomiting (Vestibular nuclei)
Ataxia (Inferior cerebellar peduncle)
Horner's Syndrome (Sympathetic projections in lateral spinothalmic area)
Absent gag reflex, dysponia, dsypnea, dysphagia (Nucleus ambiguus)

28

Horner's Syndrome

Damage to sympathetic axon on their way to the intermediolateral cell column @ T1-L2

1 Miosis
2. Ptosis
3. Anhydrosis

29

Medial medullary syndrome

-Stroke of medial medullary branches of vertebral artery

-Contralateral:
Loss of fine touch, vibration, conscious proprioception (medial lemniscus)
Spastic paralysis w/ babinski (pyramids)
Deviation of tongue to side of lesion (axon of CN XII)

Ipsilateral:
Possible atrophy and fasciculations (inferior cerebellar peduncle possible)

30

Spinal cord stroke

-Anterior/vertebral arteries

-Symptoms will be assoc. w/ pathways affected

-Presents w/ NO CORTICAL OR CN SIGNS

31

Corticobulbar tract

UMN innervation for cranial nerves

-Axons originate in cortex and terminate in motor nuclei of CNs

32

Dead Reds

Red stained neurons that are pathognomonic for ischemic stroke