Stroke Syndromes
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| Risk Factors for Stroke ? | * Hypertension -- Atrial fibrillation -- Diabetes mellitus -- Smoking -- Hyperlipidemia -- Asymptomatic carotid stenosis -- Symptomatic carotid stenosis
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| Anterior circulation = ? | * Internal carotid branches -- Middle Cerebral Artery -- Anterior Cerebral Artery
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| 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
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| ACA & MCA occlusion CxSx ? | * Abulia (lack of motivation) -- Stupor -- Hemiplegia -- Hemianesthesia -- Aphasia or anosognosia
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| Occlusion of Ophthalmic artery to retina and optic nerve = ? | * recurrent transient monocular blindness (amaurosis fugax) & horizontal shade across vision
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| If Common Carotid becomes occluded ? | * same as internal carotid
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| External carotid occlusion = ? | * Jaw claudication
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| Bilateral common carotid artery occlusions = ? | * Takayasu’s Arteritis
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| Middle Cerebral Artery (MCA)emboli CxSx = ? | * Contralateral upper extremity hemiplegia, hemianesthesia, and Homonymous hemianopsia.... * Global aphasia if dominant hemisphere
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Anosognosia , constructional apraxia & neglect if non- dominant hemisphere
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| MCA Partial Occlusions ? | * Frontal Opercular syndrome = Nonfluent (Broca) expressive aphasia (know what ppl are saying, but can't respond)
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| If Proximal superior division occlusion of MCA ? | * Nonfluent aphasia (Broca’s aphasia)
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| If Inferior division occlusion of MCA ? | * Fluent (Wernicke’s) receptive aphasia
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| 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
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| Anterior Cerebral Artery (ACA) proximal occlusion = ? | * well tolerated due to collaterals from anterior communicating artery, MCA and PCA
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| Postcommunal segment ACA Occlusion of single segment = ? If bilateral ? | * One segment = contralateral symptoms...... * Bilateral = Both hemispheres affected
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| 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
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| PCA Syndromes - P1 syndromes ? | * Infarction in ipsilateral subthalamus & medial thalamus and Infarction in ipsilateral cerebral peduncle & midbrain
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| P2 Syndromes ? | * Infarction of medial temporal & occipital lobes
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| P1 syndrome CxSx = ? | * Subthalamic nucleus = contralateral Hemiballismus (movement disorder that prevents day-to-day activities)...... * Ataxia = red nucleus and Hemiplegia = cerebral peduncle involvement
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| P1 Syndrome - Occlusion of bilateral proximal PCA ? | * Coma, Unreactive pupils, and
Decerebrate rigidity
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| P1 Syndrome - Occlusion of penetrating branches of thalamic & thalamogeniculate arteries ? | * Agonizing searing or burning pain in affected areas
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| 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
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| P2 Syndromes - Bilateral PCA occlusions = ? | * Cortical blindness with preserved pupillary light reactions
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| P2 Syndromes - Embolus of top of basilar artery ? | * Sudden onset of bilateral signs: Ptosis , Pupillary assymmetry , Lack of reaction to light
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| Vertebral Artery - Atherosclerosis in V1 and V4 ? | * Stenosis proximal to posterior inferior cerebellar artery (PICA) --> Threatens medulla and posterior inferior cerebellum
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| 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
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| 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)
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| Occlusion of anterior spinal artery ? | * quadraparesis
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| Basilar Artery - Complete basilar occlusion ? | * “Locked in” syndrome -> preserved consciousness, quadriplegia, cranial nerve signs
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| Cerebellar Arteries - Superior cerebellar artery occlusion ? | * Severe cerebellar ataxia, nausea & vomiting, dysarthria, contralateral loss of pain and temperature sensation in extremities, body & face
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| 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
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