Medicine. Discussion for ug mbbs

1. LOCALISATION OF STROKE

2. • Abrupt onset of neurological deficit that is
attributable to a focal vascular cause
• Signs and symptoms last more than 24 hours

3. RISK FACTORS
NON-MODIFIABLE:-
Age
Gender – Equal for men & women
Heredity – family history, prior transient ischemic attack, or
prior stroke increases risk

4. MODIFIABLE RISK FACTORS
High blood pressure Diabetes
Cigarette smoking TIA (Aspirin)
High blood cholesterol Obesity
Heart Disease Atrial fibrillation
Oral contraceptive use Physical inactivity
Sickle cell disease
Hypercoagulability

6. Based on symptoms
• Cortical lesion
• Focal seizures
• Aphasia
• Never produce hemiplegia
• Differential limb involvement
• Cortical senory loss

7. Corona radiata
• One limb more involved than other
• Cortical sensory loss
• No cortical signs
Internal capsule
• Dense hemiplegia
• Homonymous hemianopia
• Hemianesthesia

8. Thalamus
• Contralateral hemisensory loss
associated with agonising or burning pain
- Dejerine roussy syndrome
Brain stem
Midbrain
• Weber syn. -Ipsilateral 3rd nerve
palsy+contralateral hemiplegia
• Claud's syn - 3rd + Cintrolateral ataxia

9. Pons(4 p's)
• Pinpoint pupil
• Pyrexia
• Paralysis
• Gaze palsy
• Loss of dolls eye reflex

17. Stem occlusion
contralateral hemiplegia
contralateral hemianeasthesia
homonymous hemianopia
conjugate gaze palsy
dysarthria due to facial weakness
Dominant – global aphasia
Nondominant- constructional apraxia

18. • Distal branch- weakness of hand
weakness of hand and arm
facial weakness with Broca’s aphasia
• If superior division – motor sensory and
broca’s aphasia(FRONTAL & SUPERIOR PARIETAL
CORTEX)
• If inferior division- wernicke’s
aphasia(INFERIOR PARIETAL AND TEMPORAL
CORTEX)

23. ANTERIOR CEREBRAL ARTERY
• A1 OCCLUSION – No loss due to collateral through
anterior communicating artery
• A2 OCCLUSION – paralysis of contralateral leg
less degree paresis of
contralateral arm
cortical sensory loss of lower
limb
urinary incontinence

24. ANTERIOR CHOROIDAL ARTERY
• Arises from internal carotid artery
• Supplies posterior limb of internal capsule
• Occlusion
c/l hemiplegia, hemianesthesia,
homonymous hemianopia

25. STROKE WITHIN POSTERIOR
CIRCULATION
• POSTERIOR CEREBRAL ARTERY
• VERTEBRAL AND POSTERIOR INFERIOR
CEREBELLAR ARTERY
• BASILAR ARTERY

27. POSTERIOR CEREBRAL ARTERY
• P1 SYNDROME - C/L Hemiplegia + 3rd nerve
palsy(WEBER’S SYNDROME)
C/L ataxia + 3rd nerve palsy
(CLAUDE’S SYNDROME)
C/L Hemisensory loss followed by
agonizing pain in the affected area
(THALAMIC DEJERINE ROUSSY SYNDROME)
P2 SYNDROME -C/L homonymous
hemianopia with macula sparing

28. VERTEBRAL AND PICA

29. LATERAL MEDULLARY SYNDROME(occlusion of
vertebral, posterior inferior cerebellar,
superior, middle or inferior lateral medullary
artery)
Vertigo, Numbness of ipsilateral face
and c/l limb,diplopia, dysphagia, dysarthria,
hoarseness,ipsilateral horner’s syndrome

31. • Medial medullary syndrome(occlusion of
vertebral artery or branch of vertebral or lower
basilar artery)
ipsilateral atrophy of half the tongue
contralateral paralysis of arm and leg
sparing face

32. BASILAR ARTERY
• Supply base of pons and superior cerebellum
• Fall into three groups
PARAMEDIAN(wedge of pons on either
side of midline)
SHORT CIRCUMFERENTIAL(Lateral
2/3rd of pons,middle & superior
cerebellar peduncles)
SUPERIOR CEREBELLAR & ANTERIOR
INFERIOR CEREBELLAR(Cerebellar hemispheres)

33. BASILAR ARTERY SYNDROME
• Complete Occlusion
b/l long tract signs(sensory and motor)
Signs of cranial nerve & cerebellar
dysfunction
Occlusion of a branch
u/l motor and sensory signs and cranial
nerves

42. FEATURE THROMBOTIC EMBOLIC HAEMORRHAGIC
Age Middle or old Young Middle or old
Onset and
progression
Less rapid,
stepwise
In seconds Catastrophic,
rapidly prog.
Time of
onset
In sleep, soon
after waking
Any time During activity
Vomiting Ab, occasional Absent Recurrent
Headache Mild or absent Mild or ab Prominent
Early
resolution
Variable Possible Unusual
Meningeal
irritation
Absent Absent May be present
BP High Normal Usually high

43. FEATURE THROMBOTIC EMBOLIC HEMORRHAGIC
Carotid
bruit
Highly
supportive
Possible Not seen
CT Scan Pale infarct Pale infarct Haemorrhage
CSF Usually normal Normal Blood stained,
increased
presurre

44. THANK YOU