8/18/2019 Strokes Syndrome

1/1

Carotid System

-temporary loss of speech

-contralateral limb paralysis or parasthesia

-contralateral clumbsiness

-Amaurosis Fugax (TIA):

transient curtan-like loss of sight in ipsilateral eye

  2/2 microemboli to retina

Vertebrobasilar system

-decreased perfusion to posterior fossa

-dizziness, diplopia

-ipsilateral face numbness

-contralateral limb numbness

-dysarthia, hoarsness, dysphagia

-projectile vomiting

-headaches

-Drop attacks

Subclavian Steal

Steels blood from ipsilateral basilar system

Cerebellar Tumors

-ipsilateral ataxia

-nystagmus

-intention tremor

-Contralateral motor impairment (lower face + arm + leg)

-no sensory dfs

-no cortical dfs

-no visual dfs

-no speech dfs

  = Lacunar infart of PLIC (anterior choroidal)

-Contralateral motor & sensory impairment (face + arm + leg)

-Ipsilateral Gaze

-Ipsilateral Homonymous Hemianopia-Left MCA: aphasia

-Right MCA: hemineglect, constructional apraxia

  = MCA occlusion (lateral convex)

-Contralateral motor & sensory loss of the leg-Abulia (lack of will or initiation)

-Dyspraxia, emotional disturbance

-Urinary Incontinency

  = ACA occlusion

-Contralateral hemiplegia & ataxia

-Ipsilateral cranial nerve involvement 

  = Vertebrobasilar occlusion

  (aka brainstem / alternate syndromes)

-Contralateral hemiplegia & ataxia

-Ipsilateral occulomotor (CN3) paralysis (down & out)

  = Midbrain stroke

  = (webers, benedikt, claudes, nothnagels, parinauds)

-Gait ataxia and impaired limb coordination  (no paralysis, no CN defects)

  = Cerebellar infarction

-Contralateral motor paralysis (spastic hemiplegia) of arm & leg

-Contralateral sensory loss of touch, vibration and proprioception

-Ipsilateral tongue deviation

  = Medial medullary syndrome @ vertebrobasilar / assoc branches

-Ipsilateral Horners (PAM)

-Ipsilateral loss of facial pain & temp sensation

-Ipsilateral palate, pharynx, vocal cords

-Ipsilateral cerebellar ataxia

-Contralateral body loss of pain & temp

  = Lateral Medullary (Wallenberg)

-Ipsilateral Trigeminal motor and sensory ssx

  -Ipsilateral loss of muscles of mastication

  -Ipsilateral loss of facial sensation

-Contralateral limb ataxia

  = Lateral Pontine syndrome

-Ipsilateral limb ataxia

-Contralateral eye deviation

-Paralysis of face, arm, leg

  = Medial midpontine syndrome

Gait

PD: festinating gait

Tabes: wide, clumbsy, foot-dropping gait

Hemiparesis: extended limbs, wide semicircular movments

DMD: waddling gait 2/2 gluteal muscle weakness + gowers

Tremor

-Intention Tremor: cerebellar disease, ataxia, dysmetria, gait

-Resting Tremor: PD, Wilsons, 5hz, ↓with intention, leg s + hands

-Bilateral, sparing legs, relieved by etOH, no FNDs: ET

-Physiologic Tremor 2/2 sympathetic, ↑T3, GAD, coffee, +face, intention

STROKE: #3 MCCOD in USA, TIAs are embolic

ICP Signs: HA, meningeal, vomiting, AMS, stupor, coma

Cortical Signs: aphasia, agnosia, neglect, apraxia, hemianopsia

1) Ischemic: Abrupt FNDs + no ICP

  h/o TIAs, no HA, maintain consciousness

40% Ischemic embolic: s/s fluctuate

  2/2 athlerosclerosis (HTN, DM2)

  #1: AFIB

  #2: ICA

  #3: aorta

  #4: ASD/PFO

30% Ischemic thrombotic s/s abrupt, multi-focal

  2/2 atherlosclerosis, MCA

20% Ischemic Lacunar: small vessel thrombosis, ICP ssx

  2/2 HTN, coagulopathy, vasospasm (drugs)

3) Spontaneous SAH: Abrupt ICP + no FNDs

  2/2: rupture of betty aneurysm from AVM

tPA indicated if < 3-4.5h in an ischemic stroke

tPA contraindications:

3m stroke, h/o ICH, 14d surgery, seizure,

BP 185/110, platelets < 110, glucose < 50, INR > 1.7

Idiopathic ICP: obese women of childbearing age

  tetracyclines, hypervitaminosis A

  ssx: morning HA, transient vision loss, pulsitile tinnitus, diplopia

  PHEX: ICP → nerve sheath → papilledema, peripheral vision loss, CN6 palsy

  DX: MRI or LP w OP > 250  Tx: stop VitA or Tetracyclines, wt loss, acetazolamide

Epidural Hematoma: HA, confusion, somnolence, FNDs hours after trauma: leucid

interval, talk and die

SDH: trauma + old, bridging veins, HA, thunder-clap HA

MS: episodic numbness multi-focal, weakness, SPASTIC paraparesis, paresthesias, gait

abnormalities, vision dfs, bladder involvment

ALS: pure motor, UMN + LMN: weakness, df chewing, swallowing, cough, breath, ↑DTRs,

spasticity, fasciculations

Cyclosporine: reversible HA, visual disturbances, seisure, tremors, akinetic mutism

Wilsons = Hepato-Lenticular degeneration (liver + basal ganglia)

  ssx: resting TRAP + hepatitis + depression + hemolytic anemia

  dx: liver bx, ceruloplasmin < 20, ↑UCu excretion, KF rings

MG vs EL: Both: insidious, proximal, ptosis, diplopia

EL: ↓DTRs, autonomics

MG: dysarthia

HIT: [hep + PF4 + IgG] + platelet

= (hep-PF4-IgG)~platelet

  = platelet activation + hypersplenism

  = thrombus + thrombocytopenia

HypoK: weakness, fatigue, muscle cramps, flaccid paralysis OR tetany, hyporeflexia,

rhabdomyolysis, arrythmias ( Insulin (takes 30

mins)