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83 Cards in this Set

  • Front
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TIA Definition
temporary interrupts in cerebral circulation that give rise to neurologic deficits
TIA Duration
30-60 minutes; 10% can last up to 4 hours; most over 1 hour are considered a stroke
TIAs can mimic
seizures, postictal confusion, and migraines
Carotid TIA Symptoms
hemiparesis, hemisensory loss, parathesias, or hemianopsia; can cause a bruit; never associated with headache; can be associated with single eye blindness (due to involvement of opthalamic artery)
Parathesias
a sensation of tingling, pricking, or numbness of a person's skin
First branch of the internal carotid
Opthalamic artery
Amaurosis Fugax
Transient blindness due to occlusion (TIA) of internal carotid (because of involvement of the opthalamic artery)
Cerebral Palsy
an umbrella term encompassing a Group of non-progressive motor conditions that cause physical disability in human development, chiefly in the areas of body movement
Bruit
unusual sound that blood makes when it rushes past an obstruction (called turbulent flow)
Basilar Artery TIA Symptoms
Tingling in the mouth, dysarthria, nystagmus, ataxia and vertigo
If entire basilar artery occluded, can have "drop attack" (entire brainstem shuts down)
Vertigo most common symptom
Basilar Artery Supplies
brain stem, cerebellum, and the posterior inferior portion of the cerebrum (occipital and medial inferior portion of the temporal lobes)
Transient Global Amnesia due to Occlusion in...
Impairment in basilar artery’s terminal branches – the posterior cerebral arteries of the temporal lobe which contains limbic system
Transient Global Amnesia Symptoms
Anterograde amnesia
Retrograde amnesia for hours or days
General knowledge intact
Usually distressed
Lasts 3-24 hours
10% recurrence
most often in middle age
Percentage of strokes over age 65
75%
Hypertension is the MAJOR risk factor
thrombotic and hemorrhagic
Homocystinuria
an inherited disorder that affects the metabolism of the amino acid methionine; prone to clotting and stroke; a genetic disorder
Embolus
intravascular mass carried by circulation that can get lodged
Ischemic stroke leads to
Necrosis - cell death
ACA Stroke Symptoms
contralateral lower extremities, mutism, apathy and pseudobulbar palsy
Pseudobulbar palsy
refers to a group of symptoms—including difficulty with chewing, swallowing, and speech, as well as inappropriate emotional outbursts—that accompany a variety of nervous system disorders
MCA Stroke Symptoms
i. Hemisensory loss
ii. Aphasia
iii. Hemi-attention
PSC Stroke Symptoms
i. Contralateral homonymous hemianopsia
ii. Alexia without agraphia
Total Occlusion of Basilar Artery
Coma, locked-in syndrome
Occlusion of branch of Basilar Artery
cranial nerve palsy without hemiparesis
Wallenberg’s syndrome due to occlusion in...
Vertebral Artery or
posterior inferior cerebellar
(Lateral medullary syndrome)
Wallenberger syndrome symtpoms
aka Lateral medullary syndrome

(1) Loss of pain and temperature sensation on the contralateral (opposite) side of the body
(2) ipsilateral (same) side of the face

Clinical symptoms: difficulty swallowing, dysphagia, slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner syndrome, diplopia, possibly palatal myoclonus
Stroke and Edema
Edema most severe on 3rd to 5th day; when symptoms are most severe
Hemorrhage Onset
Abrupt, headache, nausa or vomitting; often lose consciousness
Cerebellar hemorrhage
rapids decompression of 4th ventricle – cause hydrocephalus, compression of brainstem, and can lead to respiratory failure and coma
Symptoms: occipital headache, gait ataxia, dysarthria, and lethargy
Hemorrhages usually occur in_______ due to ____________
basal ganglia, thalamus, pons, and cerebellum

hypertension
Subarachnoid hemorrhage due to
Rupture of berry anyuerism
Subarachnoid hemorrhage symptoms
causes headaches, nuchal rigidity (stiffness of the neck), but no other physical deficits
berry aneurysm
A localized, blood-filled dilation of a blood vessel or cardiac chamber caused by disease, such as arteriosclerosis, or weakening of the vessel or chamber wall
Locked-in Syndrome Symptoms
mutism, quadriplegic
alert and have INTACT COGNTIIVE CAPCITY
Normal EEG
Persistent Vegetative State
lack of self awareness, no cognitive capacity, no communication, maintain sleep-wake cycle, breathe without respirators, withdraw from noxious stimuli; caused by massive cerebral injury
Cerebral Palsy usually due to
Perinatal stroke and preterm birth
Supraclinoid/intracranial segment of internal carotid gives rise to
o Opthalamic artery (main blood supply to retina)
o Posterior Communicating Artery
o Anterior Choroidal Artery (supplying the basal ganglia, the choroid plexus of the lateral ventricle, the lateral geniculate body, the chiasm, the optic tract, and the optic radiations)
o Anterior Cerebral Artery
o Middle Cerebral Artery
Vertebral Arteries give rise to
Basilar
Posterior Cerebral Artery
Branches of vertebrobasilar system that supply brainstem and cerebellum
Posterior Inferior Cerebral Artery (PICA)
Anterior Spinal Artery
Branches of the Anterior Cerebral Artery
Pericallosal Artery (inferior)
Callosomarginal Artery (anterior)
Lenticulostriate Arteries
Arise from MCA
Supply basal ganglia and internal capsule
Prone to narrowing in hypertension
One sign of lesion: contralateral hemiparesis
Recurrent Artery of Heubner
Arise from ACA
Supplies:
o head of the caudate
o anterior putamen
o globus pallidus
o internal capsule
Thalamoperforator Arteries
Arise from PCA
Supply: Thalamus and sometimes posterior limb of the internal capsule
Posterior Choroidal arteries
Supply cerebral peduncle, fornix, thalamus, the caudate nucleus, tela chorioidea of the third ventricle, and the choroid plexus
Anterior Choroidal Artery
Arises from Internal Carotid
o globus pallidus
o putamen
o thalamus
o posterior limb of internal capsule
Gaze in large MCA infarcts
toward side of lesion
Lesion in supplementary motor area
Alien Hand Syndrome
Bilateral Occlusion of ACA
Can cause emotional disturbance with apathy, confusion, and occasional mutism, plus spastic paraparesis
Occlusion of smaller penetrating vessels of PCA
Involvement of thalamus or posterior limb internal capsule:
o Contralateral sensory loss
o Contralateral homonymous hemianopsia
o Contralateral hemiparesis
o Thalamic aphasia (if in dominant hemisphere) – so can mimic MCA infarcts
o If involve left occipital cortex and splenium of corpus callosum, alexia without agraphia
Watershed infarcts
"Man in barrel" = involvement of proximal muscles
Can also cause:
transcortical aphasia syndromes, disturbances of higher-order visual processing
Bilateral watershed infarcts
can occur with severe drops in blood pressure
TIA as risk for stroke
15% have stroke within 3 months
50% within 48 hours
Lipohyalinosis
Hypertension-related changes in vessel wall (thickening)
Associated with lacunar infarcts
Pure motor hemiparesis or dysarthric hemiparesis, symptoms
Lacunar syndrome
unilateral face, arm and leg weakness, with dysarthria
Pure motor hemiparesis or dysarthric hemiparesis, possible locations for infarct
posterior limb of internal capsule
ventral pons
corona radiata
cerebral peduncle
Ataxic hemiparesis lacunar syndrome, symptoms
unilateral face, arm, leg weakness, with dysarthia, with ataxia on same side as weakness
Ataxic hemiparesis lacunar syndrome, possible infarct locations
(same as for pure motor hemiparesis)
posterior limb of internal capsule
ventral pons
corona radiata
cerebral peduncle
Pure sensory stroke, lacunar syndrome (Thalamic Lacune)
sensory loss to all primary modalities in the contralateral face and body
Possible infarction: ventral posterior lateral thalamus (VPL)
Sensorimotor Stroke (thalamocapsular lacune)
Combo of thalamic lacune and pure motor hemiparesis
infarct: posterior limb of internal capsule and either thalamic VPL or thalamic somato-sensory radiation
Basal ganglia lacune
usually asymptomatic but may cause hemiballismus
infarct in caudatem putamen, globus pallidus, and subthalamic nucleus
Headache in ischemic stroke
25-30%; more common for posterior stroke; more common on side of stroke
Seizures in ischemic stroke
3-10%
Risk Factors for Stroke
Age
Hypertension
Hypercholesterolemia
Cardiac conditions
Diabetes
Smoking
Family history
Prior history of stroke or other vascular disease
Acute Treatment for Stroke
tissue plasminogen activator (tPA); within 4.5 hours
Contraindications for tPA
history of intracranial hemorrhage, AVM or aneurysm, active internal bleeding, abnormal platelet or coagulation studies, uncontrolled hypertension
Neuroprotectant compounds
Antioxidants, calcium-channel blockers, glutamate receptor antagonists, antagonists to cellular receptors that modulate inflammation
Deep vein thrombosis (DVT)
Blood clot in deep vein, often the leg
Hemicraniectomy
portion of skull removed over region of swelling and later replaced
Drugs to reduce stroke risk
aspirin
statins [hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors]
Carotid Stenosis
• Atherosclerotic disease commonly leads to stenosis (narrowing) of the internal carotid artery just beyond the carotid bifurcation
• Thrombi formed can embolize distally giving rise to TIAs or infarcts – most often affecting the MCA, ACA, and ophthalmic artery
• Carotid bruit is a “smoking gun” for internal carotid stenosis
Direct Venous Return
Only from the spinal cord and medulla
(the remainder of the brain supply is drained via veins that empty into the dural sinuses)
Dural Sinuses
Large channels between layers of the dura
Where CSF is reabsorbed
Superficial Veins drain...
mainly into the Superior Sagittal Sinus and the Cavernous sinus
Deep Veins drain...
into the Great Vein of Galen
Confluence of sinus = torcular Herophili (or just torcular)
Where superior sagittal, straight, and occipital sinuses join together and are drained by transverse sinus
-Right transverse sinus receives most venous blood from superior/cortical structures
-Left transverse sinus receives most venous blood from deep structures (via straight sinus)
Sagittal Sinus Thrombosis
Assoc with hypercoaguable states
Can cause elevated intracranial pressure
Symptoms of elevated intracranial pressure
o parasagittal hemorrhages
o also, increased venous pressure can decrease cerebral perfusion leading to infarcts
o seizures are common
o headaches and papilledema (optic disc swelling)
o depressed level of consciousness
Empty Delta Sign
In Saggital Sinus
Bálint's syndrome, symptoms
simultanagnosia—the inability to perceive the visual field as a whole,
ocular apraxia—a deficit of visual scanning, and
optic ataxia—an impairment of pointing and reaching under visual guidance.
Balint's syndrome, cause
Bilateral infarcts in occipito-parietal region
Perhaps due to severe hypotension
Hemiasomatognosia
Loss of awareness of entire half of body
Depression after CVA
Left-side lesion
Depression in about 30% of cases
Cerebellar Hemorrhage, Symptoms
Occipital headaches, gait ataxia, dysarthria and lethargy
Arterial Vascular Malformation (AVM)
An abnormal connection between veins and arteries, usually congenital.
leading to poor perfusion, weak areas in the vessels that may bleed, or secondary aneurysm at vessel bifurcations or junctures