Pica distribution stroke1/23/2024 ![]() ![]() Isolated events are not attributable to vertebral occlusive disease (e.g.5 Ds: Dizziness ( Vertigo), Dysarthria, Dystaxia, Diplopia, Dysphagia.Multiple, simultaneous complaints are the rule (including loss of consciousness, nausea/vomiting, alexia, visual agnosia).Crossed neuro deficits (i.e., ipsilateral CN deficits w/ contralateral motor weakness).Branches include, AICA, Basilar artery, PCA and PICA.Agnosia (inability to recognize previously known subjects).Nondominant hemisphere involved: dysarthria (motor deficit of the mouth and speech muscles understanding intact) w/o aphasia, inattention and neglect side opposite to infarct.Broca's aphasia (expressive aphasia) -> patient unable to communicate verbally, even though understanding may be intact.Wernicke's aphasia (receptive aphasia) -> patient unable to process sensory input and does not understand verbal communication.Motor deficits found more commonly in face and upper extremity than lower extremity.Hemiparesis, facial plegia, sensory loss contralateral to affected cortex.Presence of primitive grasp and suck reflexes.While comprising a small fraction of strokes, cerebellar. In the case of hemorrhagic events, bleeding can directly damage tissue and worsen these deficits. Impaired perfusion reduces oxygen delivery and causes deficits in motor and balance control. Right sided lesion: Confusion, motor hemineglect A cerebellar infarct (or cerebellar stroke) is a type of cerebrovascular event involving the posterior cranial fossa, specifically the cerebellum.Left sided lesion: akinetic mutism, transcortical motor aphasia.Contralateral sensory and motor symptoms in the lower extremity (sparing hands/face).Spatial or visual neglect (non-dominant lesion).Global aphasia, dysgraphia, dyslexia, dyscalculia, disorientation (dominant lesion).Distribution in percentages linking degree of disability at discharge. Blood supply via internal carotid system This group comprised 12 patients with PICA infarct, 1 with an SCA infarct.Cerebral amyloid angiopathy (usually found in elderly, tends to be lobar in nature).These vessels provide blood supply to parts of the frontal, temporal, and parietal lobes of the brain, as well as deeper structures, including the caudate, internal capsule, and thalamus. It branches directly from the internal carotid artery and consists of four main branches, M1, M2, M3, and M4. Cardiac failure resulting in systemic hypotension The middle cerebral artery (MCA) is the most common artery involved in acute stroke.amaurosis fugax -> emboli from a proximal carotid artery plaque embolizes to the ophthalmic artery, causing transient monocular blindness) Arterial-arterial emboli from proximal source (ex.Toxicologic exposure ( cocaine, amphetamines, etc.).Hypercoagulable state (oral contraceptives, antiphospholipid antibodies, protein S and C deficiencies, sickle cell anemia).Often preceded by yoga, spinal manipulation, coughing, vomiting.Vertebral and carotid artery dissection.Sensory Homonculus - courtesy Ischemic stroke causes (87%) Only 10% of stroke survivors will recover completely.In-hospital mortality of 5-10% for ischemic stroke and 40-60% for hemorrhagic stroke.Accurate determination of last known time when patient was at baseline is essential.Vascular injury that reduces cerebral blood flow to specific region of brain causing neuro impairment.5.2 Common Medications for BP Control in Acute Stroke.4.3 Large Vessel Occlusion - Thrombectomy.4.2 MR Imaging (for Rule-Out CVA or TIA).2.2.6 Internal Capsule and Lacunar Infarcts.2.2.5 Posterior Inferior Cerebellar Artery (PICA).2.2.4 Anterior Inferior Cerebellar Artery (AICA).Rarely, they are also seen as a complication of severe midline shift, where the ACA is occluded by mass effect or severe vasospasm. minimal sensory changes (two-point discrimination) in the same distribution as aboveĪCA territory infarcts are less common because if the A1 segment is occluded there is generally enough collateral flow via the contralateral A1 segment to supply the distal ACA territory 2.Įmbolic strokes (often with MCA involvement) are the most common cause 3.Effect of age on functional outcomes after stroke rehabilitation. Crossref Medline Google Scholar 22 Bagg S, Pombo AP, Hopman W. unilateral contralateral motor weakness (leg/shoulder > arm/hand/face) Stroke impairment predictors of discharge function, length of stay, and discharge destination in stroke rehabilitation.ACA territory infarcts are rare, comprising ~2% of ischemic strokes 1,2. ![]()
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