7.10 Stroke

Question 1

cause of stroke 85% of the time is due to?

Answer 1

infarction, not hemorrhage

Question 2

mute, neither pupil reacts to light shone in left eye, abulia, contralateral homonymous hemianopia, contralateral hemiplegia and hemisensory disturbance, gaze preference to side of lesion (left), right visual field defect in right eye

Answer 2

left internal carotid artery occlusion

Question 3

occlusion of the dominant carotid artery would cause ________, while the non dominant hemisphere would cause _________

Answer 3

aphasia, neglect

Question 4

• perfuses the optic nerve and retina
• recurrent transient monocular blindness (amaurosis fugax)
• abrupt onset of blindness, like a shade being pulled over eye

Answer 4

ophthalmic artery occlusion

Question 5

• left sided weakness
• alert and follows commands
• left hemiplegia and hemisensory loss of face and arm, leg spared
• dense left visual defect both eyes
• gaze preference to the right

Answer 5

right middle cerebral artery occlusion

Question 6

perforating branches of the MCA supply?

Answer 6

posterior limb of internal capsule, part of head and body of caudate, globus pallidus

Question 7

left/dominant MCA occlusion would cause ___________ and right/non-dominant MCA occlusion would cause __________

Answer 7

• global aphasia, alexia, agraphia, acalculia

- neglect, agnosia, apraxis

Question 8

• right sided weakness, diabetes and HTN
• alert, normal speech
• normal visual field, no gaze preference
• right hemiplegia and hemisensory loss, face arm and leg

Answer 8

occlusion of lenticulostriate arteries

Question 9

lenticulostriate arteries (M1 of MCA) supply __________ structures

Answer 9

basal ganglia (caudate, globus pallidus, putamen, posterior limb of internal capsule)

Question 10

occlusion of deep branches of the MCA or basilar artery, characterized by preservation of cortical function (language, cognitive, and visual functions)

Answer 10

lacunar syndromes

Question 11

• blurred vision, left body numbness
• alert speech, has difficult drawing a clock, Wernicke aphasia (deficit in comprehension of spoken/written language)
• no gaze preference
• left visual field defect
• normal strenght and sensation, poor left graphasthesia
• ignores left body stimuli with double simulataneous stimulation (neglect)

Answer 11

MCA Inferior Division Infarction

Question 12

• alert, frustrated, non fluent speech, follows commands
• subtle left gaze preference
• no visual defect
• right hemiparesis, face and arm greater than leg, foot is spared
• ipsilateral deviation of head/eyes
• normal sensation
• brachiofacial paralysis

Answer 12

MCA superior division infarct

Question 13

• alert, fluent speech, follows commands, affect blunted
• no gaze preference, no visual defect
• right leg weakness and numbness (sparing of face and hands)
• hyperreflexia and upgiong toe right foot
• bilateral – parapelgia affecting lower extremities, incontinence, abulia and motor aphasia, frontal lobe symptoms

Answer 13

anterior cerebral artery

Question 14

• alert, fluent speech, follows commands
• no gaze preference
• dense right visual field defect
• normal strength, sensation, reflexes
• poor short term memory

Answer 14

Posterior cerebral artery

Question 15

small perforating branches of PCA supply?

Answer 15

midbrain, choroid plexus, posterior thalamus

Question 16

cortical branches of PCA supply?

Answer 16

undersurface of temporal lobe, occipital and visual cortex

Question 17

• coma, sonorous breathing, both pupils fixed and dilated
• absent oculocephalic reflex, absent corneal reflex
• generalized hyperreflexia
• bilateral upgoing toes
• bilateral cranial nerve abnormalities, coma, long tract symptoms and signs

Answer 17

basilar artery occlusion

Question 18

• right occipital headaches, left body numbness
• alert, fluent speech, follows commands
• normal visual fields, right ptosis and miosis
• decreased sensation right soft palate
• poor thermal sensation left arm and leg
• normal strength and reflexes

Answer 18

vertebral artery occlusion