Ischemic stroke history and symptoms: Difference between revisions

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Revision as of 22:58, 7 November 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S [2]

Overview

History and Symptoms

Detailed history may suggest the underlying cause for ischemic stroke. The symptoms of a stroke are related to the anatomical location of the damage; nature and severity of the symptoms can therefore vary widely


Vessel involved	Site of infarction	History and symptoms
Anterior cerebral artery Rare Collateral circulation by anterior communicating artery	Frontal lobe Frontal cortex, Primary motor cortex	Motor weakness opposite the side of lesion Sensory loss on the same side of lesion Urinary incontinence Transcortical aphasia Abulia Disorganized thinking
	Parietal lobe Primary sensory cortex	Hemineglect (left ACA) Behavioral abnormalities
Middle cerebral artery Most common site of infarction	Right superficial division (RSD) Motor cortex (left head,neck and arm) Sensory cortex (left head, trunk and arm)	Left arm and face weakness Hemineglect
	Left superficial division (LSD) Broca's area (expressive speech area) Wernick's area (receptive speech area) Motor cortex (right head, neck and arm) Sensory cortex (right head, neck and arm)	Right arm and facial weakness Hemineglect Non fluent aphasia (Broca's aphasia) Fluent aphasia (wernick's aphasia)
	Lenticulostriate branches Striatum (caudate and putamen) Globus pallidus Internal capsule (anterior limb and genu)	Pure upper motor weakness
Posterior cerebral artery	Superficial branch Occipital cortex Splenium of corpus callosum	Homonymous hemianopsia Alexia without agraphia.
Posterior cerebral artery	Deep branch Thalamus Internal capsule (posterior limb)	Hemisensory loss Hemiparesis
Vertebrobasilar artery	Midbrain	Weber syndrome
	Medulla	Lateral medullary syndrome Medial medullary syndrome
	Pons	Locked-in syndrome
	Cerebellum	Difficulty maintaining balance Vertigo Nausea Vomiting Tremors
	Thalamus
	Occipital cortex

References

Template:WS Template:WH

@@ Line 4: / Line 4: @@
 ==Overview==
 ==History and Symptoms==
-Detailed history may suggest the underlying cause for ischemic stroke:
+Detailed history may suggest the underlying cause for ischemic stroke. The symptoms of a stroke are related to the anatomical location of the damage; nature and severity of the symptoms can therefore vary widely
 {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
 |+
@@ Line 21: / Line 21: @@
 *Motor weakness opposite the side of lesion
 *Sensory loss on the same side of lesion
-*Urinary incontinence
+*[[Urinary incontinence]]
-*Transcortical aphasia
+*Transcortical [[aphasia]]
-*Abulia
+*[[Abulia]]
-*Behavioral abnormalities
+*Disorganized thinking
-*Hemineglect (left ACA)
 |-
 |style="padding: 5px 5px; background: #F5F5F5;" |
 *Parietal lobe
 :*Primary sensory cortex
-| style="padding: 5px 5px; background: #F5F5F5;" | Put Parietal lobe findings here
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Hemineglect]] (left ACA)
+*Behavioral abnormalities
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" rowspan="3" |'''Middle cerebral artery'''
@@ Line 40: / Line 41: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Left arm and face weakness
-*Hemineglect
+*[[Hemineglect]]
-*Right arm and facial weakness
-*Non fluent aphasia (Broca's aphasia)
-*Fluent aphasia (wernick's aphasia)
-*Pure upper motor weakness (internal capsule lesion)
 |-
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Left superficial division (LSD)
-:*Broca's area (expressive speech area)
+:*[[Broca's area]] (expressive speech area)
 :*Wernick's area (receptive speech area)
 :*Motor cortex (right head, neck and arm)
 :*Sensory cortex (right head, neck and arm)
-|  style="padding: 5px 5px; background: #F5F5F5;" | LSD findings here
+|  style="padding: 5px 5px; background: #F5F5F5;" |
+*Right arm and facial weakness
+*[[Hemineglect]]
+*Non fluent aphasia ([[Broca's aphasia]])
+*Fluent [[aphasia]] (wernick's aphasia)
 |-
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Lenticulostriate branches
-:*Striatum (caudate and putamen)
+:*Striatum ([[caudate]] and [[putamen]])
-:*Globus pallidus
+:*[[Globus pallidus]]
-:*Internal capsule (anterior limb and genu)
+:*[[Internal capsule]] (anterior limb and genu)
-|  style="padding: 5px 5px; background: #F5F5F5;" | Lenticulostriate findings here
+|  style="padding: 5px 5px; background: #F5F5F5;" |
+*Pure upper motor weakness
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" | '''Posterior cerebral artery'''
+| style="padding: 5px 5px; background: #DCDCDC;" rowspan="2" | '''[[Posterior cerebral artery]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Superficial branch
 :*Occipital cortex
-:*Splenium of corpus callosum
+:*Splenium of [[corpus callosum]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Homonymous hemianopsia]]
+*[[Alexia]] without [[agraphia]].
+|-
+|style="padding: 5px 5px; background: #F5F5F5;" |
 *Deep branch
-:*Thalamus
+:*[[Thalamus]]
 :*Internal capsule (posterior limb)
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*A
+*Hemisensory loss
-*B
+*Hemiparesis
-*C
-*D
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" | '''Vertebrobasilar artery'''
+| style="padding: 5px 5px; background: #DCDCDC;" rowspan="6" | '''Vertebrobasilar artery'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Midbrain
+*[[Midbrain]]
-*Medulla
-*Cerebellum
-*Pons
-*Thalamus
-*Occipital cortex
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*[[Locked-in syndrome ]]
 *[[Weber syndrome]]
-*[[Benedikt syndrome]]
+|-
-*[[Central pontine syndrome]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
-*[[Lateral medullary syndrome]] (Wallenberg syndrome-PICA)
+*[[Medulla]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Lateral medullary syndrome]]
 *[[Medial medullary syndrome]]
-*Cerebellar infarction
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" |'''???'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Pons]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Locked-in syndrome ]]
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Cerebellum]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Difficulty maintaining balance
+*[[Vertigo]]
+*Nausea
+*Vomiting
+*Tremors
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Thalamus
+| style="padding: 5px 5px; background: #F5F5F5;" |
+|-
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Occipital cortex
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*
-*B
-*C
-*D
 |-
 |}
-Warning Signs of CVA include:
-* Sudden, severe headache with no known cause
-* Sudden trouble seeing in one or both eyes
-* Sudden confusion, trouble speaking or understanding
-* Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
-* Sudden trouble walking, dizziness, loss of balance or coordination
-Stroke [[symptom]]s typically develop rapidly (seconds to minutes). The symptoms of a stroke are related to the anatomical location of the damage; nature and severity of the symptoms can therefore vary widely. Ischemic strokes usually only affect regional areas of the brain perfused by the blocked artery. Hemorrhagic strokes can affect local areas, but often can also cause more global symptoms due to bleeding and increased intracranial pressure. On the basis of the history and [[neurological examination]], as well as the presence of risk factors, the anatomical nature of the stroke (i.e. which part of the brain is affected) can be diagnosed, even if the exact cause is not known.
-If the area of the brain affected contains one of the three prominent [[Neural pathway|Central nervous system pathways]]—the [[spinothalamic tract]], [[corticospinal tract]], and [[dorsal column]] ([[medial lemniscus]]), symptoms may include:
-* [[Hemiplegia]] and [[central facial palsy]]
-* [[Numbness]]
-* Reduced sensory or vibratory sensation
-In most cases, the symptoms affect only one side of the body (unilateral). The defect in the brain is usually on the contralateral side of the body (depending on which part of the brain is affected). However, the presence of any one of these symptoms does not necessarily suggest a stroke, since these pathways also travel in the [[spinal cord]] and spinal cord lesions can also produce these symptoms.
-In addition to the above CNS pathways, the [[brainstem]] also consists of the 12 [[cranial nerves]]. A stroke affecting the brainstem therefore can produce symptoms relating to deficits in these cranial nerves:
-* Altered smell, taste, hearing, or vision (total or partial)
-* Drooping of eyelid ([[ptosis (eyelid)|ptosis]]) and weakness of [[Extraocular muscles|ocular muscles]]
-* Decreased reflexes: gag, swallow, pupil reactivity to light
-* Decreased sensation and [[central facial palsy]]
-* [[Balance disorder|Difficulty maintaining balance]] and [[nystagmus]]
-* Altered breathing and heart rate
-* Weakness of [[sternocleidomastoid muscle]] resulting in inability to turn head to the opposite side
-* Weakness of muscles in tongue resulting in inability to protrude and/or move from side to side
-If the [[cerebral cortex]] is involved, the CNS pathways are affected in addition to the following symptoms:
-* [[Aphasia]] which is inability to speak or comprehend depending on involvement of [[Broca's area|Broca's]] or [[Wernicke's area]]
-* [[Apraxia]] (altered voluntary movements)
-* [[Visual field]] defect
-* [[Amnesia|Memory deficits]] secondary to involvement of [[temporal lobe]]
-* [[Hemineglect]] occurs contralateral to the side of [[parietal lobe]] involvement
-* disorganized thinking, confusion, [[hypersexual]] gestures (with involvement of frontal lobe)
-* [[Anosognosia]] (persistent denial of the existence of a, usually stroke-related, deficit)
-If the [[cerebellum]] is involved, the patient may have the following:
-* [[Ataxia]]
-* Altered movement coordination
-* [[Vertigo (medical)|vertigo]] and or disequilibrium
-[[Unconsciousness|Loss of consciousness]], headache, and vomiting usually occurs more often in hemorrhagic stroke than in thrombosis because of the increased intracranial pressure from the leaking blood compressing on the brain.
-If symptoms are maximal at onset, the cause is more likely to be a [[subarachnoid hemorrhage]] or an embolic stroke.
 ==References==

Ischemic stroke history and symptoms: Difference between revisions

Revision as of 22:58, 7 November 2016

Overview

History and Symptoms

References

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