Stroke

= Cerebrovascular accident (CVA)

Epidemiology

Diagnosis

Onset: sudden, no warning, symptoms maximal at onset.
Symptoms: focal, localising (usually negative: i.e., loss of function).

Headache: 25% ischaemic, 50% PICH, all SAH.
Non-focal signs are not common (LOC, blackout, collapse).

Localising the defect

Anterior circulation

Contralateral hemiparesis, sensory loss, visual field defect. Poor conjugate gaze, dysarthria, dysphagia.

Dominant hemisphere (usu. left)

Dysphasia. Difficulty reading, writing, calculating.

Nondominant hemisphere (usu. right)

Neglect, spatial disorientation, dressing apraxia, constructional apraxia.

Posterior circulation

cranial nerve palsies,
cerebellar signs,
bilateral cortical blindness, motor/sensory loss all 4 limbs.

Prognosis: variable.

Lacunar (striatocapsular) infarct

pure motor, or
pure sensory, or
pure sensorimotor, or
ataxic hemiparesis.

Cortical functions are not affected (language, cognition, vision).

Risk factors: hypertension.
Prognosis Good.

Brain stem lesions

Midbrain

Superior cerebellar artery syndrome
Benedikt's syndrome
CNIII palsy + contralateral tremor (red nucleus damage)

Pons

Anterior inferior cerebellar artery syndrome
Millard-Gubler syndrome

Medulla

Posterior inferior cerebellar artery syndrome (lateral medullary syndrome)
Locked-in syndrome

Management