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Neurological Deficits per Location of a Imad S Khan Research Fellow J.B Marshall Lab of

Neurological Deficits per Location of a

Imad S Khan

Research Fellow J.B Marshall Lab of Endovascular Neurotherapeutics

Vanderbilt University Medical Center Stroke Symposium 2013

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Disclosure

I have no relevant financial or non-financial relationships in the products and services described, evaluated or compared in this presentation.

Vanderbilt University Medical Center Stroke Symposium 2013

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Outline

What is a stroke?

Why talk about it?

Basic Anatomy of the brain

Functions of different regions of the brain

Blood supply of the brain

Introduction to stroke symptoms

Summary

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What is Stroke

400 BC. The Greek philosopher Hippocrates described the stroke phenomenon as sudden Paralysis.

Apoplexy-struck down

Vanderbilt University Medical Center Stroke Symposium 2013

phenomenon as sudden Paralysis. • Apoplexy-struck down Vanderbilt University Medical Center Stroke Symposium 2013 4

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A Brain Attack

When a clot breeches the blood supply to the brain or a vessel bursts open causing damage.

Symptoms depend on the type of stroke and the area of the brain affected.

on the type of stroke and the area of the brain affected. Vanderbilt University Medical Center

Vanderbilt University Medical Center Stroke Symposium 2013

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Why talk about it?

WHO-15 million people Worldwide claiming 5 million deaths & 5 million left with permanent damage

One American dies every 4 minutes from stroke

Approximately $73.7 billion in 2010 for stroke-related medical costs and lost productivity

4 th leading cause of death in the United States.

• 4 t h leading cause of death in the United States. Vanderbilt University Medical Center

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Stroke Belt!

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Stroke Risk Factors

Age

Sex

Race

Prior stroke

Family history

High Blood Pressure

Heart Disease

Cigarette Smoking

TIAs

Diabetes

Elevated Blood Cholesterol/Lipids

Asymptomatic Carotid Bruits

Blood Cholesterol/Lipids • Asymptomatic Carotid Bruits Vanderbilt University Medical Center Stroke Symposium 2013 8

Vanderbilt University Medical Center Stroke Symposium 2013

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Vanderbilt University Medical Center Stroke Symposium 2013 9

Vanderbilt University Medical Center Stroke Symposium 2013

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Early Action Is the Key

We need to identify the symptoms of a stroke and the high risk population

Symptoms depend on the type of stroke and the location of the brain affected.

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Anatomy of the Brain

Anatomy of the Brain Vanderbilt University Medical Center Stroke Symposium 2013 11

Vanderbilt University Medical Center Stroke Symposium 2013

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Cerebrum

Cerebrum B r a i n s t e m Cerebellum C e r e b
Cerebrum B r a i n s t e m Cerebellum C e r e b

Brain stem

Cerebellum

Cerebrum

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The lobes of the brain

Frontal Lobe

Parietal Lobe

Temporal Lobe

Occipital Lobe

• Parietal Lobe • Temporal Lobe • Occipital Lobe http://www.bioon.com/book/biology/whole/image/1/1- 8.tif.jpg

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Functions of the brain

Functions of the brain Vanderbilt University Medical Center Stroke Symposium 2013 14

Vanderbilt University Medical Center Stroke Symposium 2013

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Frontal Lobe

Frontal Lobe • Attention and concentration • Self-monitoring • Organization • Speaking (expressive language)

Attention and concentration

Self-monitoring

Organization

Speaking (expressive language)

Motor planning and initiation

Awareness of abilities and limitations

Personality

Mental flexibility

Inhibition of behavior

Emotions

Problem solving

Planning and anticipation

Judgment

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Motor Homunculus

Motor Homunculus Vanderbilt University Medical Center Stroke Symposium 2013 16

Vanderbilt University Medical Center Stroke Symposium 2013

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Temporal Lobe

Memory

Understanding language (receptive language)

Sequencing

Hearing

Organization

language) • Sequencing • Hearing • Organization Vanderbilt University Medical Center Stroke Symposium 2013 17

Vanderbilt University Medical Center Stroke Symposium 2013

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Parietal Lobe

Sensation

Touch

Pressure

Pain

Temperature

Texture

Spatial/Positional perception

Differentiation (identification) of size, shapes, and colors

Visual perception

of size, shapes, and colors • Visual perception Vanderbilt University Medical Center Stroke Symposium 2013 18

Vanderbilt University Medical Center Stroke Symposium 2013

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Sensory Homunculus

Sensory Homunculus Vanderbilt University Medical Center Stroke Symposium 2013 19

Vanderbilt University Medical Center Stroke Symposium 2013

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Orientation of the Homunculi

Orientation of the Homunculi Vanderbilt University Medical Center Stroke Symposium 2013 20

Vanderbilt University Medical Center Stroke Symposium 2013

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Occipital Lobe

Vision

Visual processes

Reading

Occipital Lobe • Vision • Visual processes • Reading Vanderbilt University Medical Center Stroke Symposium 2013

Vanderbilt University Medical Center Stroke Symposium 2013

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Brainstem • Breathing • Arousal and consciousness • Attention and concentration • Heart rate •

Brainstem

Brainstem • Breathing • Arousal and consciousness • Attention and concentration • Heart rate • Sleep

Breathing

Arousal and consciousness

Attention and concentration

Heart rate

Sleep and wake cycles

Cerebellum

Balance

Skilled motor activity

Coordination

Visual perception

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Basal Ganglia and Thalamus

Basal Ganglia and Thalamus • “The Brakes” • Modifies movement on a minute-to- minute basis •

“The Brakes”

Modifies movement on a minute-to- minute basis

Inhibits Movement

Coordination

Cortical relay

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Limbic System

Attention

Sensory gateway

Memory processing

Rage

Aggression

Sexuality

Appetite/Thirst

Rage • Aggression • Sexuality • Appetite/Thirst Vanderbilt University Medical Center Stroke Symposium 2013 24

Vanderbilt University Medical Center Stroke Symposium 2013

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Vanderbilt University Medical Center Stroke Symposium 2013

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Vanderbilt University Medical Center Stroke Symposium 2013

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Vanderbilt University Medical Center Stroke Symposium 2013 27

Vanderbilt University Medical Center Stroke Symposium 2013

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Functions related to the side of the brain

Functions related to the side of the brain Vanderbilt University Medical Center Stroke Symposium 2013 28

Vanderbilt University Medical Center Stroke Symposium 2013

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Vanderbilt University Medical Center Stroke Symposium 2013

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Types of Stroke

Ischemic Stroke

(Blockage)

Hemorrhagic Stroke

(Bleeding)

Stroke (Blockage) • Hemorrhagic Stroke (Bleeding) Vanderbilt University Medical Center Stroke Symposium 2013 30

Vanderbilt University Medical Center Stroke Symposium 2013

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Vanderbilt University Medical Center Stroke Symposium 2013 31

Vanderbilt University Medical Center Stroke Symposium 2013

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Territory of the cerebral vessels

Anterior Cerebral Artery

(light blue)

Middle Cerebral Artery

(pink)

Posterior Cerebral Artery

(light green)

Artery (pink) • Posterior Cerebral Artery (light green) Vanderbilt University Medical Center Stroke Symposium 2013 32

Vanderbilt University Medical Center Stroke Symposium 2013

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Circle of Willis

Circle of Willis Vanderbilt University Medical Center Stroke Symposium 2013 33
Circle of Willis Vanderbilt University Medical Center Stroke Symposium 2013 33

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Vanderbilt University Medical Center Stroke Symposium 2013 34
Vanderbilt University Medical Center Stroke Symposium 2013 34

Vanderbilt University Medical Center Stroke Symposium 2013

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Stroke Left Brain

Stroke Left Brain Stroke Right Brain Vanderbilt University Medical Center Stroke Symposium 2013 35

Stroke Right Brain

Stroke Left Brain Stroke Right Brain Vanderbilt University Medical Center Stroke Symposium 2013 35

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Middle Cerebral Artery (MCA) Occlusion

Contralateral lower face weakness

Contralateral hemiplegia

Contralateral hemianesthesia

Contralateral hemiplegia • Contralateral hemianesthesia • Ataxia • Speech impairments (usually the left brain)

Ataxia

Speech impairments (usually the left brain)

Perceptual deficits (usually the right brain)

Visual deficits

deficits (usually the right brain) • Visual deficits Vanderbilt University Medical Center Stroke Symposium 2013 36

Vanderbilt University Medical Center Stroke Symposium 2013

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Anterior Cerebral Artery (ACA) Occlusion

Weakness of foot and leg

Sensory loss of foot and leg

Ataxia

Incontinence

Slowness and lack of spontaneity

• Incontinence • Slowness and lack of spontaneity Vanderbilt University Medical Center Stroke Symposium 2013 37
• Incontinence • Slowness and lack of spontaneity Vanderbilt University Medical Center Stroke Symposium 2013 37

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Anterior Cerebral Artery (ACA) Occlusion

Occlusion proximal to ACOM is well tolerated

Distal Occlusion results in

Weakness and cortical sensory loss in contralateral lower limb

Incontinence

Bilateral ACA

akinetic mutism

Deterioration in conscious level

• akinetic mutism • Deterioration in conscious level Vanderbilt University Medical Center Stroke Symposium 2013 38

Vanderbilt University Medical Center Stroke Symposium 2013

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Posterior Cerebral Artery (PCA) Occlusion

Midbrain syndrome (Weber’s Syndrome)

Third nerve palsy

Contralateral hemiplegia

Thalamic Syndromes

Chorea or hemiballismus

Hemisensory disturbances

Visual field deficits (macular sparing)

Visual hallucinations

Memory problems

sparing) • Visual hallucinations • Memory problems Vanderbilt University Medical Center Stroke Symposium 2013 39
sparing) • Visual hallucinations • Memory problems Vanderbilt University Medical Center Stroke Symposium 2013 39

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Brainstem Stroke

Double vision

Face weakness and sensation weakness

Taste disturbances

Hearing loss

Difficulties in balancing and dizziness

Difficulties in swallowing

in balancing and dizziness • Difficulties in swallowing • Blood pressure and respiration dysfunction Vanderbilt

Blood pressure and respiration dysfunction

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Basilar Artery Occlusion

Complete Basilar Syndrome

Impairment of consciousness

Bilateral Sensory and Motor dysfunction

Cerebellar signs

Cranial nerve signs indicative of site

“Top of Basilar” Occlusion

Lateral midbrain, thalamic, occipital and medial lobe infarction

Hemiballismus

Visual loss

Pupillary abnormalities

Gaze palsies

Impairment of consciousness

• Gaze palsies • Impairment of consciousness Vanderbilt University Medical Center Stroke Symposium 2013 41
• Gaze palsies • Impairment of consciousness Vanderbilt University Medical Center Stroke Symposium 2013 41

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Occlusion of Paramedian Perforating Vessels

“Locked-In” Syndrome

Quadriplegia

Inability to speak

Intact cognition

May retain proprioception and sensation

Lack coordination between breathing and voice

sensation • Lack coordination between breathing and voice Paramedian perforating vessels Basilar artery Vanderbilt
sensation • Lack coordination between breathing and voice Paramedian perforating vessels Basilar artery Vanderbilt

Paramedian

perforating

vessels

Basilar artery

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Anterior Inferior Cerebellar Artery Syndrome

(Lateral Pontine Syndrome)

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Cerebellum

Ipsilateral limb ataxia

Brainstem

Ipsilateral Horner’s syndrome

Ipsilateral sensory loss

Ipsilateral facial weakness

Contralateral sensory loss (pain/temp)

Vanderbilt University Medical Center Stroke Symposium 2013

44 Posterior Inferior Cerebellar Artery Syndrome (Lateral Medullary Syndrome/Wallenberg Syndrome) Cerebellum Dysarthria
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Posterior Inferior Cerebellar Artery Syndrome

(Lateral Medullary Syndrome/Wallenberg Syndrome)

Cerebellum Dysarthria Ipsilateral limb ataxia Vertigo Nystagmus

Brainstem Ipsilateral Horner’s syndrome Ipsilateral sensory loss Ipsilateral pharyngeal and layngeal paralysis Contralateral sensory loss (pain/temp)

Vanderbilt University Medical Center Stroke Symposium 2013

Classification of subtypes of cerebral infarction

 

Clinical features

Outcome

 

Total Anterior Circulation Syndrome

Motor and sensory deficit, hemianopia and disturbance of higher mental function

Poor

Partial Anterior Circulation Syndrome

Any two of the above or isolated disturbance of cerebral function

Variable

Posterior Circulation Syndrome

Signs of brainstem dysfunction or isolated hemianopia

Variable

Lacunar Anterior Circulation Syndrome

Pure motor or sensory stroke Or pure sensorimotor stroke Or ataxic hemiparesis

Good

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Summary

Stroke is one of the most common diseases causing morbidity and mortality in the US

Stroke signs and symptoms depend upon the site of the brain affected

Different lobes have different functions

Hemispheres have different functions and control the opposite side of the body

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So when you see signs of stroke act FAST and call 9-1-1 immediately!

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Vanderbilt University Medical Center Stroke
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Any Questions???

Any Questions??? Vanderbilt University Medical Center Stroke Symposium 2013 48

Vanderbilt University Medical Center Stroke Symposium 2013

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