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