Stroke Pathology

Question 1

clinical syndromic definition of a stroke

Answer 1

• ACUTE onset
• FOCAL neurologic deficits
• referable to a VASCULAR TERRITORY
• with VASCULAR RISK FACTORS

Question 2

5 components to localization

Answer 2

1) where in the body?
2) where in the CNS
3) where is the occlusion/rupture in the vascular tree?
4) what is the source of the vascular pathology?
5) what pathology usually affects this area?

Question 3

most common type of stroke

Answer 3

• ischemic stroke/transient ischemic stroke
• –arterial

85%

Question 4

types of stroke

Answer 4

• ischemic/TIA (arterial or venous)
• intercerebral hemorrhage
• subarachnoid hemorrhage
• intraventricular hemorrhage

Question 5

amaurosis fugax

Answer 5

transient monocular vision loss

Question 6

transient monocular vision loss is a sign of ________, especially due to _______ disease

Answer 6

transient monocular vision loss is a sign of ISCHEMIC STROKE, especially due to CAROTID disease

Question 7

neurologic signs from internal carotid artery occlusion

Answer 7

Retina, frontal/temporal/parietal lobes

• amaurosis fugax (monocular vision loss)
• Horner’s syndrome
• aphasia
• weakness (2): face, arm, leg
• visual field loss
• sensory (2): face, arm, leg
• gaze paresis
• inattention
• neglect
• apraxia

headache/neck pain

Question 8

neurologic signs from MCA occlusion

Answer 8

Frontal, temporal, parietal lobes

• aphasia
• weakness: face, arm
• visual field loss
• sensory: face, arm
• neglect
• apraxia

headache/neck pain

Question 9

neurologic signs from superior division of MCA

Answer 9

frontal lobe (lateral)

• aphasia (nonfluent/motor)
• weakness: face, arm
• neglect
• apraxia
• gaze paresis

headache/neck pain

Question 10

neurologic signs from inferior division of MCA

Answer 10

temporal lobe (superior, lateral), parietal lobe (anterolateral)

• aphasia (fluent/sensory)
• visual field loss
• sensory: face, arm
• neglect
• apraxia
• agitated delirium

headache/neck pain

Question 11

neurologic signs from lenticulostriates occlusion

Answer 11

internal capsule, caudate, putamen, globus pallidus

• weakness: face, arm, leg
• sensory: face, arm, leg
• aphasia: conduction, transcortical

NO headache/neck pain

Question 12

abrupt, painless paralysis of a single limb –> think ____________

Answer 12

abrupt, painless paralysis of a single limb –> think ACA ISCHEMIC STROKE

Question 13

signs/symptoms of ACA occlusion

Answer 13

frontal lobe (medial, dorsal), parietal lobe (medial, dorsal)

• weakness: leg, +/- proximal arm
• inattention, lethargy, abulia
• sensory: leg +/- arm

headache/neck pain

Question 14

signs of occlusion of recurrent arteries of Heubner

Answer 14

Caudate, internal capsule

• abulia, akinesia
• executive dysfunction
• aphasia (L)
• hemineglect (R)

NO headache/neck pain

Question 15

posterior circulation stroke

Answer 15

• unilateral or bilateral
• multiple lesions
• incomplete or partial syndrome
• less of a vascular territory, more of a region
• clumsiness
• aphasia
• anisocoria
• loss of consciousness
• vertigo
• slurred speech
• confusion
• headache
• weakness
• anarthria
• numbness
• nausea

Question 16

why are posterior circulation strokes more difficult?

Answer 16

• frequently misdiagnosed
• accompanied by non specific symptoms
• more lethal/disabling
• dense neuroanatomy (more numerous nuclei and tracts)

Question 17

signs of vertebral artery occlusion

Answer 17

• occipital: visual field loss
• thalamus
• midbrain: medial, base, lateral
• medulla: medial, lateral
• cerebellum: ataxia (limb, truncal)
• spinal cord

headache, neck pain, nausea

Question 18

signs of anterior spinal artery occlusion

Answer 18

cervical spinal cord, thoracic spinal cord

• weakness: bilateral legs +/- arms
• sensory: pain/temp loss

back pain, neck pain

Question 19

signs of basilar artery occlusion

Answer 19

• occipital: visual field loss
• thalamus
• midbrain: medial, base, lateral
• pons: medial, base, lateral
• cerebellum: ataxia (limb, truncal)

headache, neck pain, nausea, depressed consciousness, convulsions

Question 20

signs of brainstem perforator occlusion

Answer 20

-Midbrain: medial, base, lateral
OR
-Pons: medial, base, lateral
OR
-Medulla: medial lateral

NO headache or neck pain

Question 21

signs of posterior cerebral artery occlusion

Answer 21

• occipital: visual field loss
• thalamus
• midbrain: medial, base, lateral
• balint syndrome
• gerstmann syndrome
• anton syndrome

Question 22

Balint syndrome

Answer 22

• simultanagnosia
• oculomotor apraxia
• optic ataxia

Question 23

Gerstmann syndrome

Answer 23

• agraphia
• acalculia
• finger agnosia
• left right agnosia

Question 24

Anton syndrome

Answer 24

• cortical blindness

- confabulation