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Stroke Syndromes

Risk Factors for Stroke ? * Hypertension -- Atrial fibrillation -- Diabetes mellitus -- Smoking -- Hyperlipidemia -- Asymptomatic carotid stenosis -- Symptomatic carotid stenosis
Anterior circulation = ? * Internal carotid branches -- Middle Cerebral Artery -- Anterior Cerebral Artery
If a thrombus makes its way up the internal carotid artery ? * Patent Circle of Willis is protective, and get the same CxSx as MCA syndrome
ACA & MCA occlusion CxSx ? * Abulia (lack of motivation) -- Stupor -- Hemiplegia -- Hemianesthesia -- Aphasia or anosognosia
Occlusion of Ophthalmic artery to retina and optic nerve = ? * recurrent transient monocular blindness (amaurosis fugax) & horizontal shade across vision
If Common Carotid becomes occluded ? * same as internal carotid
External carotid occlusion = ? * Jaw claudication
Bilateral common carotid artery occlusions = ? * Takayasu’s Arteritis
Middle Cerebral Artery (MCA)emboli CxSx = ? * Contralateral upper extremity hemiplegia, hemianesthesia, and Homonymous hemianopsia.... * Global aphasia if dominant hemisphere .... * Anosognosia , constructional apraxia & neglect if non- dominant hemisphere
MCA Partial Occlusions ? * Frontal Opercular syndrome = Nonfluent (Broca) expressive aphasia (know what ppl are saying, but can't respond)
If Proximal superior division occlusion of MCA ? * Nonfluent aphasia (Broca’s aphasia)
If Inferior division occlusion of MCA ? * Fluent (Wernicke’s) receptive aphasia
MCA - Lenticulostriate Occlusions ? * Lacunar Stroke In Internal Capsule = someone with high BP/HTN and see Facial Weakness followed by Arm to Leg Weakness as infarct moves anteriorly to posteriorly
Anterior Cerebral Artery (ACA) proximal occlusion = ? * well tolerated due to collaterals from anterior communicating artery, MCA and PCA
Postcommunal segment ACA Occlusion of single segment = ? If bilateral ? * One segment = contralateral symptoms...... * Bilateral = Both hemispheres affected
Artery that can become occluded during surgery for repair of aneurysm of internal carotid and CxSx with it ? * Anterior Choroidal Artery.... * See Contralateral hemiplegia, hemianesthesia (hypesthesia, and Homonymous hemianopsia
PCA Syndromes - P1 syndromes ? * Infarction in ipsilateral subthalamus & medial thalamus and Infarction in ipsilateral cerebral peduncle & midbrain
P2 Syndromes ? * Infarction of medial temporal & occipital lobes
P1 syndrome CxSx = ? * Subthalamic nucleus = contralateral Hemiballismus (movement disorder that prevents day-to-day activities)...... * Ataxia = red nucleus and Hemiplegia = cerebral peduncle involvement
P1 Syndrome - Occlusion of bilateral proximal PCA ? * Coma, Unreactive pupils, and Decerebrate rigidity
P1 Syndrome - Occlusion of penetrating branches of thalamic & thalamogeniculate arteries ? * Agonizing searing or burning pain in affected areas
P2 Syndromes - Occlusion of DISTAL PCA = ? * Infarct of calcarine cortex = Patient is aware of visual defects.....* Infarct of medial temporal lobe & hippocampus = Acute disturbances in memory if in dominant hemisphere.....* Peduncular Hallucinosis = visual halluc. of colored scenes & objects
P2 Syndromes - Bilateral PCA occlusions = ? * Cortical blindness with preserved pupillary light reactions
P2 Syndromes - Embolus of top of basilar artery ? * Sudden onset of bilateral signs: Ptosis , Pupillary assymmetry , Lack of reaction to light
Vertebral Artery - Atherosclerosis in V1 and V4 ? * Stenosis proximal to posterior inferior cerebellar artery (PICA) --> Threatens medulla and posterior inferior cerebellum
Vertebral Artery - Atherosclerosis in V2 & V3 ? *Wallenberg’s Syndrome = Lateral medulla ischemia due to V4 occlusion --> Vertigo, numbness of ipsilateral face & contralateral limbs, diplopia, hoarseness, dysarthria, dysphagia, ipsilateral Horner’s syndrome ...* Story was a girl sneezed and had this
Posterior Inferior Cerebellar Artery (PICA) - Medial medullary syndrome = ? * Contralateral hemiparesis of arm & leg (sparing face) -- Contralateral impaired tactile & proprioceptive sense -- Ipsilateral paralysis with atrophy of ½ of tongue ( NOT Face)
Occlusion of anterior spinal artery ? * quadraparesis
Basilar Artery - Complete basilar occlusion ? * “Locked in” syndrome -> preserved consciousness, quadriplegia, cranial nerve signs
Cerebellar Arteries - Superior cerebellar artery occlusion ? * Severe cerebellar ataxia, nausea & vomiting, dysarthria, contralateral loss of pain and temperature sensation in extremities, body & face
Cerebellar Arteries - Anterior Inferior Cerebellar artery occlusion ? * Ipsilateral deafness, facial weakness ... * basically see everything like in Superior, but in this one we see weakness, unlike Superior where we only see stumbling, not weakness
Created by: thamrick800