Stroke Syndromes (guest lecture) Flashcards
(25 cards)
angiography
basilar tip aneurysm; source of patient’s hemorrhage
subarachnoid hemorrhage (SAH)
bleeding in the arachnoid membrane; blood builds up between brain and skull and increases pressure; no vascular abnormality is found in ~15% of patients
subarachnoid hemorrhage symptoms
sudden onset of severe! headache +/- nausea/vomiting
prodromal headache from minor blood leakage
photophobia and visual change
seizures in >25% of patients close to onset
meningeal signs seen in 75% (neck stiffness, low back pain, bilateral leg pain; can take several hours to develop)
loss of consciousness (~50% experience at the time of bleeding onset)
location of seizure during SAH
has no relationship to the location of aneurysm
Ophthalmologic signs in SAH
retinal hemorrhage, papilledema (swelling of optic disks in eyes)
why loss of consciousness in SAH
transient intracranial circulatory arrest: the pressure impact of the hemorrhage increases intracranial pressure thus reduces Cerebral perfusion pressure
Hunt-Hess and Fisher Scale
scale to classify severity of SAH
Hunt-Hess and Fisher Scale: grade I
(hunt/hess) asymptomatic or minimal headache and slight nuchal rigidity; (fisher) no blood visualized;
asymptomatic or mild HA
Hunt-Hess and Fisher scale: grade V
(Hunt/Hess) deep coma, decerebrate rigidity, moribund appearance: highest score very bad
coma; posturing or no motor response to pain
MCA syndrome
stroke associated with middle artery syndrome
MCA symptoms
contralateral weakness (face=trunk=arm=leg)
contralateral cortical sensory loss
homonymous hemianopsia or quadrantanopsia (visual defects)
Gaze preference
Dysphagia (difficulty swallowing)
MCA syndrome: non-dominant
contralateral neglect and anosagnosia
visuospatial distortions
aprosody
apraxias
MCA syndrome: dominant
global aphasia
apraxia
Hemiplegia
paralysis affecting one side of the body (face, arm, trunk, leg)
Hemiparesis
implies a lesser degree of weakness than hemiplegia
Neglect
failure to attend to, respond to, and/or report stimulation that is introduced contralateral to the lesion
most often seen with non-dominant parietal association area lesions
affects contralateral side
persistent neglect is a negative functional outcome predictor
Apraxia
loss of ability to execute skilled or learned movement patterns on command
in absence of weakness, sensory loss, comprehension, difficulty, abnormality of tone or posture, or cognitive deficit/decline
many types
multiple sites of possible injury
Ideomotor Apraxia
plan for the movement is intact but the execution fails
due to damage within pathways connecting the areas in which the plan is conceived to those responsible for “innervating the engram”
dominant pre-motor area and dominant inferior parietal region implicated in contralateral ideomotor apraxia
bilateral apraxia may occur with unilateral lesions of the dominant supplementary motor cortex
ACA syndrome
restriction of the anterior cerebral artery;
ACA syndrome: unilateral
leg > arm motor loss (~90% of patients)
leg > face = arm cortical sensory loss
frontal release signs/inhibition of reflexes
agnosia
acquired inability to associate a perceived unimodal stimulus (visual, auditory, tactile) with meaning
disorder or recognition NOT naming
knowing wheels, handlebars and a seat but not recognizing its a bike
anosagnosia
example of agnosia; denial of deficit
prosopagnosia
example of agnosia: impaired ability to recognize faces
aphasia
impairment of language
associated with damage to the language dominant hemisphere
nearly always involves damage to the left fronto- temporal and/or temporo- parietal regions
