CVA: Difference between revisions
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'''V'''ertigo, '''A'''taxia, '''N'''ystagmus, '''I'''ntention tremor, '''S'''lurred speech (this occurs in TACS/PACS too), '''H'''eel-shin test, '''D'''ysdiochokinesis. And a broad-based gait which didn't fit. | '''V'''ertigo, '''A'''taxia, '''N'''ystagmus, '''I'''ntention tremor, '''S'''lurred speech (this occurs in TACS/PACS too), '''H'''eel-shin test, '''D'''ysdiochokinesis. And a broad-based gait which didn't fit. | ||
=== | ===LACS=== | ||
With lacunar strokes you basically get: | With lacunar strokes you basically get: | ||
*Pure motor | |||
*Pure sensory | |||
*Ataxic hemiparesis | |||
===Brainstem Stroke=== | ===Brainstem Stroke=== | ||
Essentially these come down to: headache, vertigo, nausea and vomiting; weakness, either bilateral or unilateral; visual disturbance, nystagmus, ptosis or [[Horner's syndrome]]; hearing loss; dysarthria; dysphagia; ataxia; impaired level of consciousness; and altered pattern of respiration. | Essentially these come down to: headache, vertigo, nausea and vomiting; weakness, either bilateral or unilateral; visual disturbance, nystagmus, ptosis or [[Horner's syndrome]]; hearing loss; dysarthria; dysphagia; ataxia; impaired level of consciousness; and altered pattern of respiration. | ||
Revision as of 23:37, 3 September 2010
Clinical Features
The presentation of a stroke depends on which artery/ies and so which area of the brain is affected. There are a few types of stroke that you should know about. Broadly speaking these are:
- Total Anterior Circulation Stroke (TACS)
- Partial Anterior Circulation Stroke (PACS)
- Lacunar Stroke (LACS)
- Posterior Circulation (POCS)
The other less common type of stroke is a brainstem stroke.
TACS/PACS
The symptoms important in identifying an anterior circulation stroke are:
- Higher dysfunction (aphasia, visuospatial disturbance, decreased consciousness level)
- Homonymous hemianopia
- Hemiparesis (2 of face, arm and leg)
All 3 = TACS. 2/3 = PACS.
It's actually pretty simple. Visual neglect (ignoring things on one side of vision), visual inattention (inability to see thing on one side of vision) and sensory inattention (inability to determine which side of the body is being touched) are all symptoms indicative of an anterior circulation event.
These events are usually middle cerebral artery infarcts. Anterior cerebral artery infarcts can cause: contralateral leg paralysis, urinary incontinence, grasp reflex, gegenhalten rigidity (rigidity against passive movement, perserveration (uncontrollable repetition of the same word), "alien limb" syndrome (limb takes a "mind of its own" aka Dr Strangelove syndrome - I'm not sure they're not taking the piss. Speaking of which...),
POCS
Basically, these cause cerebellar signs so think of your cerebellar examination with the acronym VANISH'D: Vertigo, Ataxia, Nystagmus, Intention tremor, Slurred speech (this occurs in TACS/PACS too), Heel-shin test, Dysdiochokinesis. And a broad-based gait which didn't fit.
LACS
With lacunar strokes you basically get:
- Pure motor
- Pure sensory
- Ataxic hemiparesis
Brainstem Stroke
Essentially these come down to: headache, vertigo, nausea and vomiting; weakness, either bilateral or unilateral; visual disturbance, nystagmus, ptosis or Horner's syndrome; hearing loss; dysarthria; dysphagia; ataxia; impaired level of consciousness; and altered pattern of respiration.