What does the ACA (anterior cerebral artery) supply?
And impairments
- frontal lobes
- parietal lobe
- Basal ganglia
- corpus collosum
Impairments:
- contralateral hemiplegia LE > UE
- sensory loss of contralateral LE> UE
- apraxia
What does the MCA (middle cerebral artery supply)?
And impairments
- portion of frontal lobe
- lateral surface of temporal/parietal lobe
- including: primary motor and sensory areas of the face, throat, hand and arm, areas for speech
Impairments:
- motor deficits in contra lateral face/ UE > LE
- sensory loss of contrateral face, UE, LE
- expressive, receptive and global aphasia
- neglect, apraxia, ability to judge distances (perceptual deficits)
- loss of conjugate gaze to contra lateral side, contra lateral homonymous hemianopsia
Posterior inferior cerebellar artery (PICA)
And impairments
- posterior, inferior portion of cerebellum and medulla
Impairments:
- Lateral Medullary syndrome (Wallenberg syndrome, PICA syndrome) - pushing ipsilateral to lesion
- nystagmus, nausea, vomiting, vertigo
- ipsilateral UE/LE limb ataxia, gait ataxia
- dysphagia/dysarthria
- contralateral loss of pain and temperature of body
- ipsilateral loss of pain and temperature to face
- ipsilateral Horner’s syndrome (smaller pupil, drooping of eyelid)
Basilar artery supplies
- midbrain
- cerebellum
- branches into PCA (posterior cerebral artery)
Superior cerebellar artery (SCA)
And impairments
- superior part of cerebellum and midbrain
Impairments:
- ataxia
- dizziness, nausea, vomiting, horizontal nystagmus
- decreased light touch, vibration, position sense of LE> UE (proprioception)
Anterior inferior cerebellar artery (AICA)
And impairments
Lateral pontine syndrome (2/3 of pons)
- anterior, inferior cerebellum
Impairments:
- sudden vertigo, vomiting, nystagmus
- ipsilateral ataxia, loss of balance to ipsilateral side, ipsilateral facial paralysis *
- ipsilateral loss of sensation of face
- ipsilateral hearing loss/ tinnitus
- contralateral loss of pain and temperature
Pontine arteries
- pons
Posterior cerebral artery (PCA)
And impairments
Temporal and occipital lobes
Impairments:
- contralateral hemiplegia
- involuntary movements, chorea, intention tremor
- oculomotor palsy
- sensory loss of contralateral UE/LE
- cortical blindness
- thalamic pain
- visual agnosia, prosopanogosia (facial recognition)
Repetitive transcranial magnetic stimulation post stroke
- translate into motor and sensory function impairments
- should be followed by motor task training
- optimal parameters are unknown
SAFE scores ( shoulder abduction and finger extension) (PREP algorithm) - predicted potential for upper limb recovery
Greater or equal to 8= excellent (by day 3)
< 8 - TMS- if MEP present= good
- if MEP absent- MRI
-if MRI shows: asymmetry index <0.15 = limited
- if MRI shows: asymmetry index > 0.15= none
MEP: motor evoked potentials in Paretic wrist extensor or first dorsal interosseous muscle
Modified Rankin Scale
- participation level measure
- ability and assistance measure
- degree of disability after a stroke
0-6
0: no disability
1: no significant disability
2: slightly disability
3: moderate disability (able to walk without assistance)
4: moderately severe disability (unable to walk without assistance)
5: severe disability (bedridden, incontinent)
6: dead
Barthel Index
0-100 - activities of daily living/mobility Cutoffs for acute stroke: - <63 = moderate disability - < 22 = severe disability
FIM
8-126 (highest score)
Burke lateralpulsion scale
Supine, sitting, standing, transfer and walking
- 17 is max score, higher is worse resistance to movement
Norms for blood glucose
Without diabetes
With diabetes
Without: 80-110 (fasting)
<140 (1-2 hrs after eating)
With: 80-130 (fasting)
<180 (1-2 hours after eating)
Cerebellar strokes
-area and impairments
Medial zone:
Medial zone: extensor tone to maintain upright balance in stance, control over flexor/extensor muscle activations during walking
Intermediate zone: pronounced Balance and walking deficits
Lateral hemisphere: voluntary aspects and modifications to locomotor cycle
- situations that involve the patient’s awareness and consciousness
STREAM
probability to home
< 63: 0% probability
51-95: 55% probability
95-100: 86% probability
Stroke to posterior limb of internal capsule
- subcortical area (does not result in cortical signs like aphasia, visual neglect or spatial neglect)
- pure motor or pure sensorimotor stroke without cortical signs
Stroke to posterior insula
Limbic system
Pseudothalalmic sensory, spatial disorientation, vestibular signs, dysarthria, aphasia
Stroke to corpus callosum impairments
- interconnects both cerebral hemispheres
- integration of sensory and motor functions
- neuropsychiatric symptoms
- relaying motor, sensory, motor and cognitive information from homologous regions to the two cerebral hemispheres
Lateropulsion Grades
Grade 1: head and body tilt without imbalance
Grade 2: head and body tilt with considerable imbalance, no falls
Grade 3: head and body tilt falls only with eyes closed
Grade 4: head and body tilt, falls with eyes open
Cortical diaschisis
Loss of function within an area of the brain distant to the site of lesion due to deafferentation of neurons
Vertebrobasilar stroke impairments
- vertigo
- visual/oculomotor disturbances
Broca’s aphasia
- lobe
- impairments/spared
- frontal lobe
- difficulty speaking/writing
- comprehension is unaffected
