17 Cerebral and Lacunar Strokes

Types of stroke

  • majority ischemic, slow onset
    • thrombosis: block in brain
    • embolism: heart emboli
    • hypoperfusion: cardiogenic shock

CNS Blood supply

  • PCA: yellow

  • blue: PCA
  • green: ACA
  • Pink: MCA
  • purple: anterior choroidal from internal carotid/MCA, posterior limb of internal capsule

MCA

  • arm affected more than leg, face also affected

  • upper portion has dual innervation from both sides of cortex

ACA

PCA

  • left visual fields of both eyes cross and processed by right posterior lobe

  • deep branches of PCA supply thalamus

Hypoxic Encephalopathy

Watershed Area

  • can move hands/feet but not thighs/shoulders

Lacunar Stroke

Locations

  • internal capsule: hemiparesis
  • thalamus: sensory loss to one side of body
  • most commonly lenticulostriate arteries from MCA (red): IC and basal ganglia

  • microatheroma: mo in vessel walls and build up of plaques

Symptoms

  • last 2 types rare
  • ataxic hemiparesis: ataxia much more than weakness. Dysarthria from cerebellar problem

Case

  • most likely motor or sensory
  • important: maybe negative initial CT