Stroke Syndromes Flashcards by Joel Glotfelty

A focal neurologic deficit of vascular origin. Caused by an abrupt incidence of vascular insufficiency or bleeding into, or immediately adjacent to the brain

Stroke (Also called a cerebrovascular accident)

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There is higher incidence and prevalence of stroke in the

Southeastern US

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Is heteromodal (combined inputs from many modalities) and makes up the majority of the human cortex

Association cortex

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Is the frontal cortex anterior to the motor, premotor, and limbic areas

Prefrontal cortex

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What are the three main functions of the frontal association cortex?

Restraint, Initiative, and Order

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The ability to inhibit inappropriate behaviors

Restraint

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The motivation to pursue positive/productive activities

Initiative

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The capacity to correctly perform sequencing tasks and cognitive operations

Order

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Cause large changes in affect, mood, and personality

Frontal Lobe Lesions

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Characterized by loss of restraint, inappropriate social behavior, loss of ambition and judgement and inability to plan for the future

Frontal Lobe Lesions

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Functions in the coordination of complex aspects of human cognition and behavior. These require the integration of thought with emotion

Prefrontal cortex

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Characterized by abulia, laughing at serious matters, and limited insight

Prefrontal cortex lesions

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Responsible for making decisions about the future, planning, and maintaining focus

-Responsible for working memory

Dorsolateral Prefrontal cortex

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Failure on Delayed Response Task This requires working memory and planning to retrieve the food after a period of time

Dorsolateral prefrontal lesions causing working memory deficits

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Dorsolateral Prefrontal Cortex is important for planning a

Goal directed movement

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Responsible for behavioral inhibition and empathy

Ventromedial/Orbitofrontal Prefrontal Cortex

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Lesions cause inappropriate behaviors and patients do not respond to images of sad, happy, or angry faces

Lesions to Ventromedial/Orbitofrontal Prefrontal Cortex

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An Example of an Orbitofrontal/Ventromedial Lesion is

-Most common type

Frontotemporal lobe dementia

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Damage to the right parietal association cortex causes

Contralateral hemineglect syndrome

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Ignorance of visual, somatosensory, or auditory stimuli, despite intact primary sensation.

-Drawing, reading and writing can reveal

Sensory neglect

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Motor inattention to one side of the body, despite normal reflexes and strength: eyes deviated to side of lesion

Motor Neglect

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Patients perceive their body as upright even when it is tilted to the side. Patients will also tend to gaze towards the lesion (away from the neglected side)

Motor Neglect

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Lack of awareness of neglect. Lack of personal hygiene and grooming. Disownershipof affected part

Anosognosia

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The process of selectively focusing on one aspect of the environment

Attention

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The right parietal association cortex functions in

Attention

A right hemisphere lesion causes severe

Left neglect

A left hemisphere lesion causes minimal

Right neglect

Attentional processes are largely in the

Right Hemisphere

We have better attention mechanisms to the

Left

Extinction tests can uncover

Neglect

Patients with neglect will have normal responses to individual stimuli/commands, but demonstrate “extinction” on the

Neglected side

Each side tested alone patient will see/feel

Sensory extinction

Move each arm separately, and then both together to look for neglected arm or Allokinesia

Motor extinction

Moving the wrong arm to the command

Motor extinction

Stroke deficits arise from the

Subcortical structures and pathways

Medial portions of the frontal lobe and anterior parietal lobe are supplied by the

ACA

The regions supplied by the ACA have representations in

Lower limb motor and sensory function

Contralateral hemiparesis and sensory deficits are greater in the leg than the arm with

ACA stroke

What kind of aphasia do left sided ACA strokes cause?

Transcortical Motor Aphasia

The ACA deep branches are called the

Recurrent Arteries of Heubner

Supplies the anterior limb of the internal capsule and the caudate-putamen

Recurrent Arteries of Heubner (aka medial striate artery)

Characterized by contralateral hemichorea and contralateral weakness in the face and arm

Recurrent Arteries of Heubner strokes

Travels to the lateral cortex with several branches supplying subcortical regions -Largest cerebral artery

Middle Cerebral Artery (MCA)

Deep penetrating “lenticulostriate” vessels supply the

Internal Capsule and Basal Ganglia

Prone to narrowing, particularly in patients with longstanding hypertension

Lenticulostriate arteries

Lenticulostriate arteries are common sites of lacunar infarct. This causes

Contralateral hemiplegia (pure motor hemiparesis) and possibly basal ganglia signs

Small lenticulostriateinfarcts may only affect

Ascending or descending pathways

In the posterior limb of the internal capsule, motor pathways (FAL) are anatomically separate from somatosensory pathways (fal) with motor pathways being

Anterior to Somatosensory

Lesions of the posterior limb of the internal capsule causes

Pure motor hemiparesis

These lesions to the posterior limb of the internal capsule are from one of three arteries. What are they?

1. ) Anterior choroidal artery 2. ) Lenticulostriate artery 3. ) Branch of PCA

Usually supplies the region anterior to the central sulcus

Superior division of MCA

Supplies the region posterior to central sulcus together wit temporal regions

Inferior divisions of MCA

Causes contralateral UMN paralysis with upper limb deficits being greater than lower limb and the face

Superior divisions of MCA

Strokes in the superior divisions of MCA affect the

Motor Cortex

What do we see in the gaze of a patient with infarct in superior divisions of MCA?

Horizontal gaze to opposite side

What other deficits do we see in a superior division MCA infarct if it is on the 1. ) Left 2. ) Right

1. ) Speech motor | 2. ) Attention

An infarct to the inferior divisions of the MCA affects the

Sensory cortex (sensory loss is greater to upper limbs than lower and face)

What other deficits do we see in a inferior division MCA infarct if it is on the 1. ) Left 2. ) Right

1. ) Speech sensory | 2. ) Attention

With an inferior division of MCA infarct, we also see losses in

Visual field

Supplies visual radiations

Inferior divisions of MCA

Causes severe sensorimotor deficit in the contralateral body. (pre-and post-central gyri and internal capsule)

MCA stem stroke

Transient paralysis of horizontal gaze to the opposite side, with gaze preference towards the side of the lesion. (frontal eye field)

MCA stem stroke

If the MCA stem stroke is on the left side, we see

Global aphasia

If the MCA stem stroke is on the right side, we see

Neglect

Confusion-agitation from temporal lobe damage can occur with

MCA stem stoke

Pure motor hemiparesis from a lesion in the internal capsule, ventral pons, or cerebral crus is an example of

Subcortical lesion

Motor paresis and associated cortical signs from a lesion in the cortex is an axample of a

Cortical lesion

A deep branch from the internal carotid artery

Anterior Choroidal Artery

The anterior choroidal artery supplies the

Optic Tract and Internal Capsule

Characterized by contralateral homonymous hemianopsia and contralateral hemiplegia

Anterior choroidal artery syndrome

Symptom of anterior choroidal artery syndrome due to lesion to the optic tract

Contralateral homonymous hemianopsia

Supplies midbrain, thalamus, medial temporal and occipital lobe

Posterior Cerebral Artery

Left-sided PCA strokes cause

Transcortical sensory aphasia

Inability to read because the information from the left visual field cannot cross into the language areas (for interpretation of written language)

Alexia

Patients can write, because language and hand movements are intact, but cannot read what they write with -Caused by PCA infarct

Alexia

Deep or stem strokes can produce contralateral

Hemianesthesia

Deep or stem PCA strokes may produce

Central pain syndrome

5-10% of all strokes are

Watershed infarcts

Cause “Man in a barrel” syndrome with sensory and motor loss of the proximal upper limbs, but little effect on the legs

MCA-ACA watershed infarcts

Which type of aphasia are caused by ACA-MCA watershed infarcts?

Transcortical motor aphasia

Which type of aphasia is caused by MCA-PCA infarcts?

Transcortical sensory aphasia

Neurons shut down, but may be restored when cerebral blood flow drops below

20mL/100g/min

Tissue necrosis (infarct) is seen when cerebral blood flow drops below

10mL/100g/min

Blood clot forms usually at site of atherosclerosic plaque, causing occlusion -High risk factor in persons with cerebrovascular disease

Thrombus

A piece of material (usually blood) that lodges in a cerebral blood vessel. -Commonly caused by atrial fibrillation

Embolus

An angular gyrus lesion causing agraphia and/or alexia with mild aphasia

Gerstmann syndrome

Causes acalculia and right-left confusion, finger agnosia -“touch your right ear with your left thumb”

Gerstmann syndrome

Disconnection of right hemisphere vision from left hemisphere language -Word blindness

Alexia without Agraphia

Stroke Syndromes Flashcards

(88 cards)