Localisation of stroke

Medicine. Discussion for ug mbbs

1. LOCALISATION OF STROKE

2. Abrupt onset of neurological deficit that is attributable to a focal vascular cause Signs and symptoms last more than 24 hours

3. RISK FACTORS NON-MODIFIABLE:- Age Gender – Equal for men & women Heredity – family history, prior transient ischemic attack, or prior stroke increases risk

4. MODIFIABLE RISK FACTORS High blood pressure Diabetes Cigarette smoking TIA (Aspirin) High blood cholesterol Obesity Heart Disease Atrial fibrillation Oral contraceptive use Physical inactivity Sickle cell disease Hypercoagulability

5. Based on symptoms Cortical lesion Focal seizures Aphasia Never produce hemiplegia Differential limb involvement Cortical senory loss

6. Corona radiata One limb more involved than other Cortical sensory loss No cortical signs Internal capsule Dense hemiplegia Homonymous hemianopia Hemia n esthesia

7. Thalamus Contralateral hemisensory loss associated with agonising or burning pain - Dejerine roussy syndrome Brain stem Midbrain Weber syn . - Ipsilateral 3rd nerve palsy + contralateral hemiplegia Claud's syn - 3 rd + Cintrolateral ataxia

8. Pons ( 4 p's ) Pinpoint pupil Pyrexia Paralysis Gaze palsy Loss of dolls eye reflex

9. Stem occlusion contralateral hemiplegia contralateral hemianeasthesia homonymous hemianopia conjugate gaze palsy dysarthria due to facial weakness Dominant – global aphasia Nondominant - constructional apraxia

10. Distal branch- weakness of hand weakness of hand and arm facial weakness with Bro ca’s aphasia If superior division – motor sensory and broca’s aphasia(FRONTAL & SUPERIOR PARIETAL CORTEX) If inferior division- wernicke’s aphasia(INFERIOR PARIETAL AND TEMPORAL CORTEX)

11. ANTERIOR CEREBRAL ARTERY A1 OCCLUSION – No loss due to collateral through anterior communicating artery A2 OCCLUSION – paralysis of contralateral leg less degree paresis of contralateral arm cortical sensory loss of lower limb urinary incontinence

12. ANTERIOR CHOROIDAL ARTERY Arises from internal carotid artery Supplies posterior limb of internal capsule Occlusion c/l hemiplegia , hemianesthesia , homonymous hemianopia

13. STROKE WITHIN POSTERI O R CIRCULATION POSTERIOR CEREBRAL ARTERY VERTEBRAL AND POSTERIOR INFERIOR CEREBELLAR ARTERY BASILAR ARTERY

14. POSTERIOR CEREBRAL ARTERY P1 SYNDROME - C/L Hemiplegia + 3 rd nerve palsy(WEBER’S SYNDROME) C/L ataxia + 3 rd nerve palsy (CLAUDE’S SYNDROME) C/L Hemisensory loss followed by agonizing pain in the affected area (THALAMIC DEJERINE ROUSSY SYNDROME) P2 SYNDROME -C/L homonymous hemianopia with macula sparing

15. VERTEBRAL AND PICA

16. LATERAL MEDULLARY SYNDROME(occlusion of vertebral, posterior inferior cerebellar , superior, middle or inferior lateral medullary artery) Vertigo, Numbness of ipsilateral face and c/l limb,diplopia , dysphagia , dysarthria , hoarseness,ipsilateral horner’s syndrome

17. Medial medullary syndrome(occlusion of vertebral artery or branch of vertebral or lower basilar artery) ipsilateral atrophy of half the tongue contralateral paralysis of arm and leg sparing face

18. BASILAR ARTERY Supply base of pons and superior cerebellum Fall into three groups PARAMEDIAN(wedge of pons on either side of midline) SHORT CIRCUMFERENTIAL(Lateral 2/3 rd of pons,middle & superior cerebellar peduncles) SUPERIOR CEREBELLAR & ANTERIOR INFERIOR CEREBELLAR( Cerebellar hemispheres)

19. BASILAR ARTERY SYNDROME Complete Occlusion b/l long tract signs(sensory and motor) Signs of cranial nerve & cerebellar dysfunction Occlusion of a branch u/l motor and sensory signs and cranial nerves

20. FEATURE THROMBOTIC EMBOLIC HAEMORRHAGIC Age Middle or old Young Middle or old Onset and progression Less rapid, stepwise In seconds Catastrophic, rapidly prog. Time of onset In sleep, soon after waking Any time During activity Vomiting Ab, occasional Absent Recurrent Headache Mild or absent Mild or ab Prominent Early resolution Variable Possible Unusual Meningeal irritation Absent Absent May be present BP High Normal Usually high

21. FEATURE THROMBOTIC EMBOLIC HEMORRHAGIC Carotid bruit Highly supportive Possible Not seen CT Scan Pale infarct Pale infarct Haemorrhage CSF Usually normal Normal Blood stained, increased presurre

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