Stroke

Your Path

  • Stroke

Etiology

  • Ischemic (85%): Cardioembolic (20%); Atherothrombotic (25-30%); Lacunar/Small Vessel (15-20%); Cryptogenic 25-30%; Other/Uncommon (5-10%) e.g. paradoxic from PFO, ASD, HHT
  • Hemorrhagic (15%): Bleeding into and/or around the brain
  • Cerebral venous sinus thrombosis

Risk Factors

  • Hypertension
  • Smoking
  • Diabetes
  • Past stroke
  • Hyperlipidemia
  • COVID 19
  • Family history vascular disease
  • Atrial fibrillation
  • Left ventricular thrombus
  • Prosthetic valve
  • Hypercoaguable state
  • For cerbebral venous sinus thrombosis (CVT): inflammation, hypercoaguable state

Symptoms

  • Acute loss of an objective neurological function, typically reaching peak severity of symptoms in seconds to minutes
  • Anterior Circulation - Left Middle Cerebral Artery (dominant hemisphere): Can affect frontal, temporal and parietal lobes - can cause aphasia (Brocas--> expression or Wernickes--> comprehension), left gaze preference, right visual field deficit (homonymous hemianopsia), right hemiparesis (facial droop, drift, plegia), right hemisensory loss
  • Anterior Circulation - Right Middle Cerebral Artery: Can affect frontal, temporal and parietal lobes; can cause right gaze preference, left visual field defect, left hemiparesis, left hemisensory loss, left neglect (doesn't move left side of body, doesn't feel touching of left side, doesn't see object in left field)
  • Anterior Circulation (Anterior Cerebral Artery): Frontal lobes - contralateral leg weakness more than arm, disinhibition, loss of executive function
  • Posterior Circulation (Vertebral-Basilar System - PCA): Can affect occipital, medial temporal lobes and thalamus; can cause cortical blindness, homonymous hemianopsia, behavior changes, contralateral sensory loss, aphasia, impaired executive function, decreased loc, memory impairment
  • Posterior Circulation (Verebral-Basilar System): Other symptoms include - crossed motor and sensory findings (ie ipsilateral face, contralateral body), nystagmus, ataxia, vertigo, diplopia from eye movement abnormalities, dysarthria, tongue deviation, Horner's syndrome, dysphagia, locked-in syndrome
  • Posterior Circulation (SCA, AICA, PICA): Cerebellar - ataxia, nystagmus, nausea/vomiting, dysarthria, headache, loss of consciousness
  • Lacunar (thrombosis of penetrating arteries): pure motor (posterior limb internal capsule) to face, arm, leg; pure sensory (thalamic) w/numbness of face, arm, leg; motor and sensory (juncture between thalamus and internal capsule); unilateral ataxia and weakness (corona radiata); dysarthria, dysphagia, decreased fine motor/clumsy hand
  • Cerebral Venous Sinus Thrombosis: Heache (increased ICP) and/or focal deficits (venous infarct)

Physical Exam Findings

  • Abrupt loss of discrete neuro function
  • Weakness, loss of vision, speech, sensation, gait/balance, loc, cognition, memory or other objective findings based on location of stroke