17 Cerebral and Lacunar Strokes
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Types of stroke
- majority ischemic, slow onset
- thrombosis: block in brain
- embolism: heart emboli
- hypoperfusion: cardiogenic shock
CNS Blood supply
- 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
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