neuroanatomy stroke syndromes linking imaging …...neuroanatomy stroke syndromes linking imaging to...
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NeuroanatomyStrokeSyndromesLinkingImagingtoSymptoms
D R . W I E S L AW O C Z KOWS K I
P RO F E S S O R , D E PA R TM EN T O F M E D I C I N E ( N E U RO LOGY )
M E D I C A L D I R E C TO R R E G I ONA L S T RO K E P ROG R AM
MCMA S T E R U N I V E R S I T Y, H AM I LTON H E A LT H S C I E N C E S
None
DisclosuresandConflictsofInterest
Overviewoftheneurologicalassessment
Whyisissoimportantinstroke
Neurologicalsignsandimaging
Neurologicallocalizationwithcases
Objectives
Bill
72yearoldmale
§Hypertension
§Smoker
Strokecall:dizzy,facialdroop,slurredspeech
NeurologicalExam:
§Ptosisandmiosis onleft
§Numbleftface
§ Leftpalatalweakness
§Dysarthria
§Ataxicleftarmandleftleg
§Numbrightarmandleg
NIHStrokeScale
LOC:a,b,c_________________
Bestgaze__________________
Visualfields________________
Facialpalsy________________
Motorarmandleg__________
Limbataxia________________
Sensory_______________________
BestLanguage______________
Dysarthria_________________
Extinctionandinattention____§ (tone,reflexes,distalsensation,gait)
Score
0
0
0
0
0
2
1
0
1
0
-
-Left Ptosis
-Left miosis
-Weakness of
left palate
EKGofStroke
6
TroponinofStroke
8
It’s all about Stroke!
FocalMotororSensory
Presentation
Stroke NotStroke
AMeasuringandMonitoringNeurologicalExamination
LOC:a,b,c_________________
Bestgaze__________________
Visualfields________________
Facialpalsy________________
Motorarmandleg__________
Limbataxia________________
Sensory___________________
BestLanguage______________
Dysarthria_________________
Extinctionandinattention____§ (tone,reflexes,distalsensation,gait)
Score
Top - Down
Left - Right
Patient - Examiner
Hemispheres
Brainstem
Spinal Cord
Nerves
Muscles
Neuromuscular
Junction
Assess orientation (“How old are you?, What month is it?”)
Assesstheabilitytodescribethepicture
Assesstheabilitytoreadthesentences
Assessvisualfieldsandassessforinattention(4quadrants)
Assessthepupillarylightreflex
Assess eye movements following the “H” pattern
Assessfacialsensation(leftandrightcheekusingsharpanddull)
Assessfacialmovements(closeeyes,smile)
Assess palatal and tongue movements (say “ah”, stick out tongue)
Assesstoneinthe4limbsAssessstrengthusingdriftandarmrollingtests
Assessdistalsharp-dullandvibrationsensationandsensoryinattention
Assessreflexes(biceps,brachioradialis,triceps,quadriceps,AchillesandBabinski)
Assess limb coordination (finger to nose, heel – knee – shin)
Assessgaitandtandemwalking(tandemgait,normalgait)
TheNervousSystemisDistributed
AspectScoring
ASPECTSCORING
Roger57yearoldmale
◦ Atrialfibrillation
◦ CAD,CHF
◦ Pacemaker
◦ DM2
◦ HTN,DL
Presentedwithsuddenleftsidedweakness
Roger
Maria
66yearoldfemale
◦ HTN
◦ DL
◦ Depression
Foundathomeonthefloorunabletotalkandwithrightsidedweakness
Maria
Virginia91yearoldfemale
◦ Atrialflutter
◦ CHADS=1
Medications:ASA
Presentedwithsuddenonsetofinabilitytospeak
Virginia
Livia70yearoldfemale
◦ Hypertension
◦ Dyslipidemia
◦ Anxietyanddepression
Coronaryangiography
Postangiogramheadache
unabletosee
Livia
Christinia82yearoldfemale
◦ Hypertension
◦ Diabetes
◦ Dyslipidemia
Collapsewithsuddenrightlegweakness
Christina
Gladys85yearoldfemale
◦ Hypertension
◦ Dyslipidemia
FoundonthefloorwithadecreasedLOC
Slurredspeech,vomiting,andrightarmweakness
Gladys
Wayne68yearoldmale
◦ Atrialfibrillation
◦ PreviousTIA
◦ Hypertension
Hikingwithhiswife
Dizziness,lossofbalance,doublevision,leftweakness
Wayne
Complete ptosis
Eye laterally deviated
Greg31yearoldmale
◦ Well
Collapsed
BroughttoERwithleftweakness
Greg
Linda63female
◦ Previousstrokewith complete recovery
◦ Atrialfibrillation
◦ Diabetestype2
Presentedwithseveredysarthria,andleftweakness
Bill72yearoldmale
◦ Hypertension
◦ Smoker
Strokecall?
Bill
Left Ptosis
Left miosis
Weakness of left palate
Harry65yearoldmale
◦ Smoker
◦ COPD
Difficultywalking
Difficultybreathing
Admittedtostepdownandthenward
Unabletourinateandambulate
Harry
Sensory level at T4
NeuroanatomyStrokeSyndromesLinkingImagingtoSymptoms
D R . W I E S L AW O C Z KOWS K I
P RO F E S S O R , D E PA R TM EN T O F M E D I C I N E ( N E U RO LOGY )
M E D I C A L D I R E C TO R R E G I ONA L S T RO K E P ROG R AM
MCMA S T E R U N I V E R S I T Y, H AM I LTON H E A LT H S C I E N C E S