CVA

Verse for the Day

“ If any of you lacks wisdom, he should ask God,

who gives generously to all without finding fault, and
it will be given to him. ”
James 1:5
TOPIC OUTLINE
 Definition & Epidemiology
 Risk Factors
 Classification
 Temporal
 Pathophysiological
 Neuroanatomical
Definition
 Cerebrovascular accident
 NONTRAUMATIC
 VASCULAR CAUSE
 SUDDEN NEUROLOGIC DEFICIT
 Epidemiology
 Old > Young
 Male > Female
 Black > White
 Asian > US
Risk Factors
 Modifiable  Non-modifiable
 Lifestyle  Race
 Cigarette smoking  Age
 Hypercholesterolemia  Sex
 Obesity  Previous stroke
 Heart disease
 Medical
 TIA
 LEADING RISK
 DM FACTOR
 Asymptomatic carotid  Hypertension
bruit
 ↑ hematocrit/serum
fibrinogen
Classification: Temporal
 TIA
 Reversible ischemic neurologic deficit
 Stroke in evolution
 Completed stroke
Classification: Pathophysiological
 Ischemic  Hemmorhagic
 Thrombotic  Intracerebral
 Embolic
 Subarachnoid
 Hypertensive
 Lacunar
 Other
Classification: Neuroanatomical
 ICA
 MCA
 ACA
 PCA
 Lacunar
 Brainstem
MCA
 Contralateral hemiplegia
 Contralateral hemianesthesia
 Frontal gaze palsy
 Aphasia/Aprosodia & Affective agnosia
 Apraxia
 Contralateral hemianopsia
 Dysphagia
ACA
 Contralateral hemiplegia
 Contralateral hemianesthesia
 Uninhibited neurogenic bladder
 Primitive reflexes
 Disconnection apraxia
 Akinetic mutism/abulia
PCA
 Visual impairment
 Visual agnosia
 Memory deficit
 Hemisensory deficit
Lacunar
 Pure Motor
 Posterior limb of internal capsule
 Pure Sensory
 VPL nucleus of thalamus
 Dysarthria with facial weakness
 Anterior limb of internal capsule
 Dysarthria with clumsy hand
 Dorsal pons
 Ataxic hemiparesis
 Ventral pons
Lacunar Bridge
(London Bridge)

Lacunar bridge is falling down

VPL Thalamus, sensory fall down
Posterior limb, motor fall down
It’s in internal capsule

Anterior limb, voice & face fall down

Dorsal pons, voice & hand fall down
Ataxic plus body half fall down
It’s in ventral pons
 Brainstem
Syndrome Area Ipsi Contra
Weber medial basal midbrain CN III hemiplegia
Benedikt tegmetum of midbrain CN III pain & T°,
proprioception, tremor,
chorea, ataxia
Locked-In bilateral basal pons (+) upward gaze only
Millard-Gubler lateral pons CN VI, VII hemiplegia
Wallenberg lateral medulla CN X & V, ataxia, pain & T° of body
(PICA/Lateral nystagmus,
Medullary Horner’s syndrome,
Syndrome) pain & T° of face
AICA cerebellum, brainstem CN V, VI, VII, pain & T° of body
ataxia, Horner’s
syndrome, pain &
T° of face
SCA cerebellum, brainstem ataxia, Horner’s pain & T° of body & face
Prognosis
 Poor Predictors
 coma at onset
 persistent incontinence
 poor cognitive
function
 severe hemiplegia
 lack of return of motor
function after 1 month
 prior stroke
 visual-spatial
perceptual deficit
 unilateral hemineglect
 significant
cardiovascular disease
 large cerebral lesion
 presence of multiple
neurologic deficits
Medical Management
 Thrombosis & TIA
 Spasticity
 Seizures
 RSD