CVA
CVA
Verse for the Day
“ If any of you lacks wisdom, he should ask God, who gives generously to all without finding fault, and it will be given to him. ”
James 1:5
TOPIC OUTLINE Definition & Epidemiology Risk Factors Classification
Temporal Pathophysiological Neuroanatomical
Definition Cerebrovascular accident
NONTRAUMATIC VASCULAR CAUSE SUDDEN NEUROLOGIC DEFICIT
Epidemiology Old > Young Male > Female Black > White Asian > US
Risk Factors Modifiable
Lifestyle Cigarette smoking Hypercholesterolemi
a Obesity Heart disease
Medical TIA DM Asymptomatic
carotid bruit ↑ hematocrit/serum
fibrinogen
Non-modifiable Race Age Sex Previous stroke
LEADING RISK FACTOR Hypertension
Classification: Temporal TIA Reversible ischemic neurologic deficit Stroke in evolution Completed stroke
Classification: Pathophysiological Ischemic
Thrombotic Embolic Lacunar
Hemmorhagic Intracerebral Subarachnoid Hypertensive
Other
Classification: Neuroanatomical ICA MCA ACA PCA Lacunar Brainstem
MCA Contralateral hemiplegia Contralateral hemianesthesia Frontal gaze palsy Aphasia/Aprosodia & Affective agnosia Apraxia Contralateral hemianopsia Dysphagia
ACA Contralateral hemiplegia Contralateral hemianesthesia Uninhibited neurogenic bladder Primitive reflexes Disconnection apraxia Akinetic mutism/abulia
PCA Visual impairment Visual agnosia Memory deficit Hemisensory deficit
Lacunar Pure Motor
Posterior limb of internal capsule Pure Sensory
VPL nucleus of thalamus Dysarthria with facial weakness
Anterior limb of internal capsule Dysarthria with clumsy hand
Dorsal pons Ataxic hemiparesis
Ventral pons
Lacunar Bridge(London Bridge)
Lacunar bridge is falling downVPL Thalamus, sensory fall downPosterior limb, motor fall downIt’s in internal capsule
Anterior limb, voice & face fall downDorsal pons, voice & hand fall downAtaxic plus body half fall downIt’s in ventral pons
BrainstemSyndrome Area Ipsi Contra
Weber medial basal midbrain
CN III hemiplegia
Benedikt tegmetum of midbrain
CN III pain & T°,proprioception, tremor, chorea,
ataxiaLocked-In bilateral basal pons (+) upward gaze only
Millard-Gubler lateral pons CN VI, VII hemiplegiaWallenberg
(PICA/Lateral Medullary Syndrome)
lateral medulla CN X & V, ataxia,
nystagmus, Horner’s
syndrome, pain & T° of face
pain & T° of body
AICA cerebellum, brainstem
CN V, VI, VII, ataxia, Horner’s syndrome, pain
& T° of face
pain & T° of body
SCA cerebellum, brainstem
ataxia, Horner’s syndrome
pain & T° of body & face
Prognosis Poor Predictors
coma at onset persistent
incontinence poor cognitive
function severe hemiplegia lack of return of
motor function after 1 month
prior stroke
visual-spatial perceptual deficit
unilateral hemineglect
significant cardiovascular disease
large cerebral lesion presence of multiple
neurologic deficits
Medical Management Thrombosis & TIA Spasticity Seizures RSD