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83 Cards in this Set
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TIA Definition
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temporary interrupts in cerebral circulation that give rise to neurologic deficits
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TIA Duration
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30-60 minutes; 10% can last up to 4 hours; most over 1 hour are considered a stroke
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TIAs can mimic
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seizures, postictal confusion, and migraines
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Carotid TIA Symptoms
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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)
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Parathesias
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a sensation of tingling, pricking, or numbness of a person's skin
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First branch of the internal carotid
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Opthalamic artery
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Amaurosis Fugax
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Transient blindness due to occlusion (TIA) of internal carotid (because of involvement of the opthalamic artery)
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Cerebral Palsy
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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
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Bruit
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unusual sound that blood makes when it rushes past an obstruction (called turbulent flow)
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Basilar Artery TIA Symptoms
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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 |
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Basilar Artery Supplies
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brain stem, cerebellum, and the posterior inferior portion of the cerebrum (occipital and medial inferior portion of the temporal lobes)
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Transient Global Amnesia due to Occlusion in...
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Impairment in basilar artery’s terminal branches – the posterior cerebral arteries of the temporal lobe which contains limbic system
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Transient Global Amnesia Symptoms
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Anterograde amnesia
Retrograde amnesia for hours or days General knowledge intact Usually distressed Lasts 3-24 hours 10% recurrence most often in middle age |
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Percentage of strokes over age 65
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75%
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Hypertension is the MAJOR risk factor
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thrombotic and hemorrhagic
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Homocystinuria
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an inherited disorder that affects the metabolism of the amino acid methionine; prone to clotting and stroke; a genetic disorder
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Embolus
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intravascular mass carried by circulation that can get lodged
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Ischemic stroke leads to
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Necrosis - cell death
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ACA Stroke Symptoms
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contralateral lower extremities, mutism, apathy and pseudobulbar palsy
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Pseudobulbar palsy
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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
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MCA Stroke Symptoms
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i. Hemisensory loss
ii. Aphasia iii. Hemi-attention |
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PSC Stroke Symptoms
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i. Contralateral homonymous hemianopsia
ii. Alexia without agraphia |
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Total Occlusion of Basilar Artery
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Coma, locked-in syndrome
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Occlusion of branch of Basilar Artery
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cranial nerve palsy without hemiparesis
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Wallenberg’s syndrome due to occlusion in...
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Vertebral Artery or
posterior inferior cerebellar (Lateral medullary syndrome) |
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Wallenberger syndrome symtpoms
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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 |
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Stroke and Edema
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Edema most severe on 3rd to 5th day; when symptoms are most severe
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Hemorrhage Onset
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Abrupt, headache, nausa or vomitting; often lose consciousness
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Cerebellar hemorrhage
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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 |
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Hemorrhages usually occur in_______ due to ____________
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basal ganglia, thalamus, pons, and cerebellum
hypertension |
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Subarachnoid hemorrhage due to
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Rupture of berry anyuerism
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Subarachnoid hemorrhage symptoms
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causes headaches, nuchal rigidity (stiffness of the neck), but no other physical deficits
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berry aneurysm
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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
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Locked-in Syndrome Symptoms
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mutism, quadriplegic
alert and have INTACT COGNTIIVE CAPCITY Normal EEG |
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Persistent Vegetative State
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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
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Cerebral Palsy usually due to
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Perinatal stroke and preterm birth
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Supraclinoid/intracranial segment of internal carotid gives rise to
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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 |
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Vertebral Arteries give rise to
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Basilar
Posterior Cerebral Artery Branches of vertebrobasilar system that supply brainstem and cerebellum Posterior Inferior Cerebral Artery (PICA) Anterior Spinal Artery |
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Branches of the Anterior Cerebral Artery
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Pericallosal Artery (inferior)
Callosomarginal Artery (anterior) |
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Lenticulostriate Arteries
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Arise from MCA
Supply basal ganglia and internal capsule Prone to narrowing in hypertension One sign of lesion: contralateral hemiparesis |
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Recurrent Artery of Heubner
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Arise from ACA
Supplies: o head of the caudate o anterior putamen o globus pallidus o internal capsule |
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Thalamoperforator Arteries
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Arise from PCA
Supply: Thalamus and sometimes posterior limb of the internal capsule |
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Posterior Choroidal arteries
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Supply cerebral peduncle, fornix, thalamus, the caudate nucleus, tela chorioidea of the third ventricle, and the choroid plexus
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Anterior Choroidal Artery
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Arises from Internal Carotid
o globus pallidus o putamen o thalamus o posterior limb of internal capsule |
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Gaze in large MCA infarcts
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toward side of lesion
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Lesion in supplementary motor area
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Alien Hand Syndrome
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Bilateral Occlusion of ACA
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Can cause emotional disturbance with apathy, confusion, and occasional mutism, plus spastic paraparesis
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Occlusion of smaller penetrating vessels of PCA
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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 |
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Watershed infarcts
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"Man in barrel" = involvement of proximal muscles
Can also cause: transcortical aphasia syndromes, disturbances of higher-order visual processing |
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Bilateral watershed infarcts
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can occur with severe drops in blood pressure
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TIA as risk for stroke
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15% have stroke within 3 months
50% within 48 hours |
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Lipohyalinosis
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Hypertension-related changes in vessel wall (thickening)
Associated with lacunar infarcts |
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Pure motor hemiparesis or dysarthric hemiparesis, symptoms
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Lacunar syndrome
unilateral face, arm and leg weakness, with dysarthria |
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Pure motor hemiparesis or dysarthric hemiparesis, possible locations for infarct
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posterior limb of internal capsule
ventral pons corona radiata cerebral peduncle |
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Ataxic hemiparesis lacunar syndrome, symptoms
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unilateral face, arm, leg weakness, with dysarthia, with ataxia on same side as weakness
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Ataxic hemiparesis lacunar syndrome, possible infarct locations
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(same as for pure motor hemiparesis)
posterior limb of internal capsule ventral pons corona radiata cerebral peduncle |
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Pure sensory stroke, lacunar syndrome (Thalamic Lacune)
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sensory loss to all primary modalities in the contralateral face and body
Possible infarction: ventral posterior lateral thalamus (VPL) |
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Sensorimotor Stroke (thalamocapsular lacune)
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Combo of thalamic lacune and pure motor hemiparesis
infarct: posterior limb of internal capsule and either thalamic VPL or thalamic somato-sensory radiation |
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Basal ganglia lacune
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usually asymptomatic but may cause hemiballismus
infarct in caudatem putamen, globus pallidus, and subthalamic nucleus |
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Headache in ischemic stroke
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25-30%; more common for posterior stroke; more common on side of stroke
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Seizures in ischemic stroke
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3-10%
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Risk Factors for Stroke
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Age
Hypertension Hypercholesterolemia Cardiac conditions Diabetes Smoking Family history Prior history of stroke or other vascular disease |
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Acute Treatment for Stroke
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tissue plasminogen activator (tPA); within 4.5 hours
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Contraindications for tPA
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history of intracranial hemorrhage, AVM or aneurysm, active internal bleeding, abnormal platelet or coagulation studies, uncontrolled hypertension
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Neuroprotectant compounds
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Antioxidants, calcium-channel blockers, glutamate receptor antagonists, antagonists to cellular receptors that modulate inflammation
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Deep vein thrombosis (DVT)
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Blood clot in deep vein, often the leg
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Hemicraniectomy
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portion of skull removed over region of swelling and later replaced
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Drugs to reduce stroke risk
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aspirin
statins [hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors] |
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Carotid Stenosis
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• 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 |
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Direct Venous Return
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Only from the spinal cord and medulla
(the remainder of the brain supply is drained via veins that empty into the dural sinuses) |
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Dural Sinuses
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Large channels between layers of the dura
Where CSF is reabsorbed |
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Superficial Veins drain...
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mainly into the Superior Sagittal Sinus and the Cavernous sinus
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Deep Veins drain...
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into the Great Vein of Galen
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Confluence of sinus = torcular Herophili (or just torcular)
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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) |
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Sagittal Sinus Thrombosis
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Assoc with hypercoaguable states
Can cause elevated intracranial pressure |
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Symptoms of elevated intracranial pressure
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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 |
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Empty Delta Sign
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In Saggital Sinus
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Bálint's syndrome, symptoms
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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. |
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Balint's syndrome, cause
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Bilateral infarcts in occipito-parietal region
Perhaps due to severe hypotension |
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Hemiasomatognosia
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Loss of awareness of entire half of body
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Depression after CVA
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Left-side lesion
Depression in about 30% of cases |
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Cerebellar Hemorrhage, Symptoms
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Occipital headaches, gait ataxia, dysarthria and lethargy
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Arterial Vascular Malformation (AVM)
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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 |