HD2 Week 3
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15 terms
Terms | Definitions |
|---|---|
 Localizing stroke: subcortical | Lenticulostriate arteries off of MCA. Supplies deep subcortical structures, i.e. basal ganglia, internal capsule. Presents with weakness/sensory loss WITHOUT aphasia, neglect, visual field deficits, gaze preference. |
| Localizing stroke: lacunar | Small infarct affecting subcortical structures (basal ganglia, internal capsule, thalamus) PURE motor hemiparesis and/or hemisensory loss, clumsy hand dysarthria syndrome. - Many due to microatheroma, emboli. Many are clinically silent. Lacunar stroke can be mimicked by large vessel disease. |
| Anterior vs. Middle cerebral arteries | Anterior: MEDIAL part of parietal, temporal, frontal lobes. LEG weakness. Bilateral stroke-->akinetic mutism (not motivated to speak). Middle: LATERAL part of parietal, temp, front. ARM and FACE weakness. Visual field deficits, gaze preference, aphasia (if dominant hemisphere), neglect if non-dom hemisphere |
| Localizing stroke: posterior cerebral artery | (From basilar a., which in turn is from vertebrals, which are from subclavians.) VISUAL FIELD deficits-->contralateral homonymous hemianopsia! |
| Localizing stroke: basilar artery | Basilar supplies the Brainstem and Back of Brain! - Cranial nerve dysfunction - Cerebellar dysfunction - Occasionally loss of consciousness, which is otherwise NOT seen with ischemic stroke. - May show CROSSED/bilateral sensory/motor deficits. |
| Localizing stroke: vertebral artery | LOWER CN deficit and/or ataxia. CROSSED sensory signs. Wallenberg syndrome. |
| Wallenberg syndrome | a.k.a. lateral medullary syndrome, posterior inferior cerebellar artery syndrome. Often MISSED by MRI. Vertebral dissection most common cause in YOUNG person. - CONTRAlateral pain & temp deficits in trunk and extremities, IPSIlateral facial pain & temp sensation loss. Presents with Horner's, dysphagia, diplopia, and facial pain. NO corneal reflex--trigeminal shot. - Due to damage of spinothalamic tract, cerebellum, trigeminal nucleus. Stroke in VERTEBRAL a. or PICA. CAREFUL not to confuse this with CAROTID DISSECTION! |
| What labs are drawn in suspected stroke? | CBC, lytes, coags, cardiac panel, arterial blood gas. Stat CT scan as well to rule out hemorrhage. Clinical clues to hemorrhage: headache, nausea/vomiting, very high BP. |
| Localizing lesions: subarachnoid hemorrhage | "Worst headache of life" CAN present with focal signs (e.g. 3rd nerve palsy) CT scan has decent sensitivity, but LP should be performed if CT negative. Positive LP results: CSF xanthochromatic/grossly bloody. Angiography needed to ID vascular problem (aneurysm vs. vascular malformation). |
| Most common locations for aneurysm | Anterior communicating (30%) Posterior communicating (25%) Middle cerebral a. (20%) Vertebro-basilar (~10%) Risk of rupture highest in posterior comm. and vertebro-basilar areas. Risk higher with larger size and hx of previous rupture. |
| Carotid dissection | CAREFUL--this can also present with crossed signs and Horner's, but is NOT Wallenberg's! e.g. Right-sided neck pain, RIGHT Horner's, LEFT weakness. - Notice weakness vs. sensory loss. |
| Warfarin therapy for stroke prevention | Used in patients with A-fib. ASA not a great choice for a-fib. OTHERWISE, asa is fine. Similar success rate to warfarin for preventing recurrent stroke. |
| Atherosclerosis of large vessels: tx options | - Carotid stenosis is most common - Stenting vs. endarterectomy--generally similar results. - Favor stenting in cases of high risk for MI, recurrent stenosis after surgery, post-radiation stenosis, etc. |
| ABCDD scoring for risk of stroke FOLLOWING a TIA | Age >60 BP >140/90 Clinical sx of speech impairment/focal weakness Diabetes Duration 10-59 min (1 pt) or over 1 hour (2 pts) Highest scores correlated with a stroke rate of over 20% within the next 90 days. |
| Atherosclerotic vs. Embolic strokes: different appearances grossly | - Atherosclerotic strokes are usually large and pale. - Embolic strokes are usually hemorrhagic |
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