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

• 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