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angulations of arteries)
Origin of Common carotid Artery, MCA (transition from
Common Carotid or its main bifurcation), Junction of vertebral
arteries with the basilar artery
Epidemiology:
old>young
Male>female by 1.25x
Black>white by 2x
Asian>American
Risk Factors:
Modifiable(HOLS):Hypertension- 4-6x
lifestyle
Smoking-2x
Hypercholesterolemia/ hyperlipedemia
`HDL- good
cholesterol N- 60-120/ greater than 60 (why good? Adheres to LDL,
takes it to interstitial space to be absorbed preventing deposition in
blood vessels
LDL bad cholesterol N- <100 (low density, floats in blood and
becomes deposited in walls of blood vessels causes
atherosclerosis)
Triglycerides- N- <165 Total- <200 (to-two)
b. Embolus- 20%
Embolus- (not refer only to dislodged thrombus) any foreign object,
quantity of air or gas, bit of tissue or tumor, or piece of a thrombus
that circulate in the bloodstream until it becomes lodged in a vessel
(intra arterial, cerebral, fat, air, septic)
Onset gradual
TIA- (-)
Arteries- smaller- MC affected- MCA
MC origin- heart
MC Cardiac Cause: Atrial Fibrillation stasis (slow or stopped blood
flow) hypercoagulability thrombus formation heart valves open
thrombus exits blocks arteries in the brain
Manifestations- milder than thrombotic but more severe than lacunar
Obesity
Non Modifiable (RAPS):
Medical (DTH2):
DM- 5x viscosity of blood- settles/
forms aggregate- risk for development of thrombus
TIA- chance to develop stroke- 5% with in 2 days, 10% with
in 3 mos, 35% with in 5 years
Hematocrit/ Serum Fibrinogen- causes generalized reduction
of cerebral blood flow; chance of developing blood clot
Heart disease (rheumatic heart valvular disease, endocarditis,
cardiac surgery)- embolic stroke
Atrial Fibrillation- 5x increased risk
Etiologic Classification:
1. IschemiaArteriosclerosis- hardening from loss of elasticity of of bld vessel;
inability to constrict and dilate
*Atherosclerosis- hardening 2 to plaque formation with accumulation
of lipids, fibrin, complex carbohydrates and calcium deposits in arterial
walls that leads to progressive narrowing of blood vessels
Lateral
2. subarachnoid occurs from
Frontal
MCA
bleeding into sub arachnoid space
Parietal
MCA
usually from a saccular or berry
Temporal
MCA
aneurysm affecting usually large
Occipital
MCA
blood vessel;
-closely linked to chronic hypertension170/90 chance for rupture
3. AVM Atriovenous Mlaformatio- abN connection bet arteries and
vein with no capilliaries in between, Abnormal vessel undergo
progressive dilatation with age and eventually bleed in 50% of the
cases.
*brodmans area
Frontal
4 primary
Motor
6 pre motor or
motor
association
8- frontal eye
field
9,10,11
Judgment,
insight,
personality
44,45- Broccas
Temporal
Parietal
Medial
Voluntary
Motor perception and
ACA
Fxn
recognition
ACA
of auditory
Intelligence/
PCA
stimuli
Cognitive
PCA
(hearing)
function
Memory
(short
Speech
term)
Emotion
Learning)
personality
center Seat of
personality
Judgment &
conscience
Long term
memory
Occipital
Temporal
41,42- Primary
auditory
22- Wernickes
Sensory lobe
Visual
Paraytal- all
cortex
body sensation perception
except for visual
,
and hearing
processin
touch, pressure,
g
temperature &
pain.
awareness of the
body in space &
spatial relation
analyzes and
relays sensory
info to other
parts of the brain
Gustatory cortex
Parietal
3,1,2 Primary
Sensory
5,7 Sensory
assoc.
43 Gustatory
area
39 angular
Occipital
17- primary
visual area
18,19secondary
visual
BROCAS
FRPS
BEEMAN
non-fluent
Expressive
Motor
Anterior
Executive
aphasia
44,45- Brocas
area
Syntactic
Aphasia
Neuroanatomical Classification /
Clinical Syndromes
*MULA- MCA UPPER, Lower
ACA
1. MCA SYNDROME- Most common
4,6- Contra Hemiplegia UE>LE
Pre motor or parietal cortex-limb
kinetic apraxia
3,1,2- contra Hemi anesthesia
40- Apraxia
LEFT
(DOMINANT)
Gerstmann
syndrome
Ideomotor
Ideational
Parietal lobe
Ataxia
Ideational
22- Wernickes
area
Semantic
Wernickes Aphasia
(fluent, receptive,
sensory, posterior)
Aprosodia- monotonous
speech
Amelodosia- no melody
with songs
UE>LE
8- loss of conjugate eye movement to opposite side (looks towards
side of lesion, away from hemi side)
APHASIA- Impairment of language comprehension, formulation and use
AGNOSIA- inability to recognize a familiar object with one sensory
modality (visual, tactile, auditory, etc.)
APRAXIA- inability to perform learned movements; (-)task
conceptualization; (-)task sequencing; no idea how to do the movt,
cant formulate required motor programs
Ideational- (-)movts on command; (-) automatic movements;
Ideomotor- (-)movts on command, (+) automatic movts;
habitual tasks ; (+)perseveration
39,40, PART OF WERNICKES
AREAS OF THE
BRAIN
39- (angular)
Broccas Aphasia
(non-fluent,
expressive, motor,
anterior,
executive)
RIGHT
2. ACA
Contra h2 (hemiplegia, hemianesthesia) LE> UE
Urinary incontinence
Apraxia- Disconnection apraxia Problems with imitation and bimanual
task lesion to corpus callosum
Akinetic mutism (abulia) coma vigil alert but totally unresponsive,
no movement, no sound
Perseveration- same answer on diff. questions or doing the same thing
+ Grasping (gegenhalten) and sucking reflex
Dressing
Constructional
Geographic
Perceptual deficits- Neglect
syndrome, Anosognosiadenial of neurological
deficits Spatial
disorganization
Affective agnosia
Amusia
grasp at suck nya ang pulis (grasp & sucking reflex). Hindi na
gustuhan ng pulis, tinanong siya pabalik balik ang sagot
(perseveration) kaya tinutukan na sya ng baril- biglang nanigas di na
gumalaw di na nagsalita (akinetic mutism)
Vertebral
Artery Synd.
Webers
3. PCA
3ps Photodeficits- visual deficits
Pain syndrome- thalamic pain syndrome / Dejerine RousyDejerine Araysy
Past memory deficits- inferomedial temporal affectation
Benedikts
Lock in
Milliard
Gubler
AICA
SUCA
4. Lacunar
Manifestations
Pure sensory
Pure Motor
Dysarthria with clumsy hand
Dysarthria with facial weakness
Ataxia with hemiparesis
Song- lacunar bridge is falling down *note correction
Medial
basal
midbrain
Tegmentum
of midbrain
Bilateral
basal pons
Lateral pons
Cerebellum,
brainstem
Cerebellum,
brainstem
syndrome,
pain and Temp
of face
CN III
Hemiplegia
CN III
Manifestations
Stage 4- hand behind back
Sup /pron with Elbow flex 90
Sh. Flexed to 90
Stage 5Arm abducted to 90