Strokes n' Shiiiii

General- Ischemic

• Clot of blockage → most common type 80% of CVA

  • Cerebral thrombosis: blood clot w/in the cerebral arteries

  • Cerebral embolism: traveling bits of matter produce occlusion (from other locations)

General- Hemorrhagic

• Rupture or leakage→ less common, worse prognosis

• Hematomas can lead to hemorrhage

Epidural hematoma

• between the skull and dura

  • Caused by a tear of the meningeal arteries

  • Brain is affected by the compressed fluid

Subdural hematoma

• midline shift; crescent shape, between dura and arachnoid space

  • Tearing of bridging veins b/t brain and dural sinus (venous)

    • Acute onset accompanied by headaches and AMS

    • C/L hemiparesis

    • May have epilepsy

Subarachnoid

• Unable to identify lateral ventricles; between arachnoid and pia

  • bleeding into brain (fills)

  • Thunderclap headache

  • worse prognosis (often leads to death)

  • All gray; cannot see any ventricles

TIA- Transient Ischemic Attack

• Temporary interruption of blood supply to the brain

• May last a few minutes to several hours < 24 hours

• Precursor to susceptibility for cerebral or myocardial infarction

Anterior cerebral artery (ACA)

• Area of brain

  • Anterior frontal lobe

  • Medial surface of frontal lobe

  • Medial surface of parietal lobe

• S/S

  • C/L loss of LE motor and sensory function

  • Loss of bowel and bladder fxn

  • Aphasia, apraxia, agraphia, akinetic mutism

Middle cerebral artery (MCA)

• Area of brain

  • Cerebrum

  • Basal ganglia

• S/S

  • UE more affected

  • C/L weakness and loss of face sensory function

  • Wernicke aphasia, apraxia, anosognosia

  • Homonymous hemianopsia

Internal Carotid artery (ICA)

• Area of brain

  • parietal lobe

• S/S

  • Supplies both the MCA and ACA, so s/s can include all those that would occur with infarcts of either artery

    • Lesions involving both MCA and ACA can lead to massive edema, brain herniation, and death

  • s/s of MCA involvement with reduced consciousness

  • Warning signs: Hx of TIAs and temporary fading of vision in I/L eye

Posterior cerebral artery

• Area of the brain

  • Occipital lobe

  • Midbrain

  • Thalamus

• S/S

  • C/L hemiplegia

  • C/L loss of pain and temperature sensation

  • Prosopagnosia- inability to recognize faces

Vertebral basilar artery

• Area of the brain

  • Cerebellum

  • Medulla

  • Pons

• S/S

  • Locked-in syndrome: patient cannot move or speak but is A&O

  • No horizontal eye mvmt, but vertical eye mvmt/ blinking intact

  • Pseudobulbar palsy d/t CN V-XII paralysis

  • Tetraplegia

  • Rapid progression from hemiparesis to tetraplegia or quadriplegia

Internal Capsule

• S/S

  • supranuclear palsy

  • weakness of C/L lower half of face and C/L extremities

  • Decreased corticobulbar tract function

• Differentiate b/t SCI and CVA

  • An SCI never affects the face, so if the face is affected you know the CVA is above the midbrain

Brain stem

• S/S

  • Both I/L (face) and C/L (limb) impairments

    • R stroke → R sided face, L sided arm weakness

  • Any injury above the medulla with present with only C/L loss

Cerebellum

• S/S

  • I/L impairments

  • Ataxia, dysdiadochokinesia, dysmetria, dyssynergia, dysphagia

Side specific s/s- Right CVA

• s/s on left

  • L-sided weakness or paralysis

  • L-sided neglect → spatial and perceptual problems

  • poor judgement/ impulsiveness

  • overestimates abilities

  • difficulty perceiving emotions

  • rigidity in thought

  • short attention span/ poor memory

  • cognitive problems

• Think toddler

Side specific S/s- Left sided CVA

• S/s on right

  • Right-sided weakness or paralysis

  • Aphasia: wernicke's or broca’s

  • Cautious, slow, insecure

  • Aware of impairment; frustrated

  • depressed; sad

  • difficulty processing information in a linear and sequential manner

  • difficulty understanding new info

• Think old person

Stroke Man

• ACA- LE deficits

• MCA- UE and face

• PCA- Visual