Signs and Symptoms of Ischemic Stroke

Symptoms are characterized by...

vessel territory/location of stroke

which arteries can cause aphasia when blocked?

ICA, MCA,

which arteries can cause neglect when blocked?

ICA, MCA,

ICA (internal carotid artery) stroke symptoms

aphasia (dominant hemisphere), neglect (nondominant hemisphere), contralateral homonymous hemianopsia, motor and sensory loss, conjugate ipsilateral eye deviation, central retinal artery occlusion, amaurosis fugax, Horner's syndrome, miosis, facial anhidr

what is contralateral homonymous hemianopsia?

only sees one side

contralatera definition

pertaining to the other side

ipsilateral definition

pertaining to the same side

what is conjugate ipsilateral eye deviation?

stuck looking toward the area that was affected

What is amaurosis fugax?

transient monocular blindness d/t retinal ischemia (loss of blood flow to eye)

what is horner's syndrome?

ptosis, miosis, anhydrosis (particularly facial anhidrosis)

what is miosis

pupil constriction

what is anhidrosis

inability to sweat

MCA (middle cerebral artery) stroke symptoms

aphasia (dominant), neglect (nondominant), contralateral motor/sensory loss of face, arm, and leg (leg<arm), homonymous hemaniopsia, conjugate ipsilateral eye deviation, agnosia

What is homonymous hemianopsia?

loss of half the visual field

what is agnosia?

neglect or lack of self awareness

when is agnosia usually seen?

strokes in the R hemisphere

what is abulia?

lack of concern or disinhibition

what is alexia?

inability to read

what is agraphia?

loss of ability to write or spell

what is prosopagnosia?

loss of ability to recognize faces

ACA (anterior cerebral artery) stroke symptoms

contralateral motor/sensory deficits (leg>arm) but the tongue and face are spared, abulia, possible primitive frontal reflexes like grasp and suck

which artery when blocked off affects the leg more than the arm with motor deficits?

ACA

which artery when blocked off affects the arm more than the leg with motor deficits?

MCA

Which artery when blocked causes Horner's syndrome?

ICA

PCA (posterior cerebral artery) stroke symptoms

contralateral visual field homonymous hemianopsia and visual agnosia, alexia with or without agraphia and prosopagnosia, Weber's syndrome, Parinaud's syndrome; total blindness and amnesia (when bilaterally occluded)

What symptoms characterize pure PCA strokes?

Do not include paralysis or aphasia, but sensory loss may be present

what is Weber's syndrome?

Ipsilateral CN III (occulomotor) palsy, contralateral hemiplegia, and significant bulbar dysfunction

what arterial occlusion can cause Weber's syndrome?

PCA

what is Parinaud's syndrome?

impaired up-gaze, convergence retraction nystagmus, primary conjugate downgaze

what arterial occlusion can cause Parinaud's syndrome?

PCA

PICA (posterior inferior cerebellar artery) stroke symptoms

Wallenberg's syndrome, dysphagia, dysarthia, dysphonia, ipsilateral loss of corneal reflex

What is Wallenberg's syndrome?

loss of pain and temperature sensation in the contralateral trunk and ipsilateral face

what arterial occlusion can result in wallenberg's syndrome?

PICA

what is dysphagia?

difficulty swallowing

what is dysarthria?

slurred speech

what is dysphonia?

difficulty speaking

AICA (anterior inferior cerebellar artery) stroke symptoms

lateral pontine syndrome, ipsilateral loss of sensation to face, ipsilateral facial paralysis and hearing loss, nystagmus

what is lateral pontine syndrome?

vertigo, vomiting, nystagmus, falling toward side of lesion

what arterial occlusion can lead to lateral pontine syndrome?

AICA

what symptoms can be found in both the AICA or PICA?

dysfunction of speech, tremor, occular findings (nystagmus), abnormal gait, abnormal finger-to-nose/heel-to-shin testing

what does the finger-nose/heel-shin test indicate?

dysmetria

what is dysmetria?

inability to control the distance, power, and speed of a muscular action

BA (basilar artery) stroke symptoms

vertebrobasilar artery syndrome, mixed motor exam, dysconjugate gaze, and AMS with increased lethargy, Millard-Gubler syndrome; can result in locked-in syndrome and akinetic mutism
(BA=Bad Ass stroke.. and not the good kind of bad ass)

what is locked-in syndrome?

AKA akinetic mutism; Complete loss of physical movement, but totally cognitively aware; your consciousness is locked in a body that you cannot move. Pt's may be able to move their eyes in order to communicate, but gaze paresis (internuclear opthalmoplegia

what is internuclear opthalmoplegia (INO)

ocular movement disorder caused by a lesion of the medial longitudinal fasciculus. It is characterized by impaired adduction of the ipsilateral eye with nystagmus of the abducting eye

What is Millard-Gubler Syndrome?

Ventral pontine syndrome: diplopia, inability to rotate affected eye outward, ipsilateral weakness of facial muscles, and loss of corneal reflexes

Brain stem stroke symptoms

N/V, diplopia, dysarthria, dysphagia, dysconjugate gaze, gaze palsy, vertigo, tinnitus, hemiparesis/quadriplegia, sensory loss in hemibody/all four limbs, rapid decline in LOC, hiccups, abnormal respirations