Cerebrovascular Disease

David Darrow, Lora Kahn, Sean Barber, Jaime Gasco, Joel T. Patterson, and Javier Gonzalez

27.1 General Aspects

How is a stroke defined?

A clinical syndrome characterized by focal or nonfocal neurological deficits caused by abnormalities of cerebral blood circulation

How are strokes classified?

• Ischemic (80–87%)

• Hemorrhagic (13–20%)1

Why is it important to differentiate between ischemic and hemorrhagic stroke?

Because the causes, prognosis, and treatment are significantly different

What is a transient ischemic attack (TIA)?

• Acute loss of focal cerebral or monocular function

• Symptoms last less than 24 hours and without residual symptoms

• Most symptoms last less than 1 hour

What is the risk of CVA after a TIA?

• 3 to 5% risk of CVA at 48 hours²

• 10.5% risk of CVA over 90 days post-TIA³

How is ischemic stroke classified?

• Large artery

• Cardioembolic

• Lacunar (small vessel)

• Undetermined

• Cryptogenic

• More than one mechanism

• Incomplete evaluation

• Other

What are the symptoms of an internal carotid artery (ICA) occlusion?

Contralateral hemiparesis, hemianesthesia, hemianopia, aphasia; global aphasia (dominant hemisphere [DH]), denial or hemineglect (nondominant hemisphere [NDH])4

What are the symptoms of anterior choroidal artery occlusion?

Same findings as for middle cerebral artery syndrome (see below) but language spared, pure motor or sensory stroke, ataxic hemiparesis, various intellectual deficits⁴

What are the symptoms of ophthalmic artery occlusion?

Ipsilateral monocular blindness or amaurosis fugax⁴

What are the symptoms of anterior cerebral artery occlusion?

Anterior cerebral artery: weakness, clumsiness, and sensory loss affecting mainly distal contralateral leg

• Small branches: tactile anomia or ideomotor apraxia of limbs

• Huebner’s artery: contralateral weakness of arm and face with or without rigidity or dystonia

• Cortical branches: contralateral weakness and sensory loss in leg; if bilateral, behavior disturbances⁴

What are the symptoms of middle cerebral artery occlusion?

Hemiplegia (face, arm, and leg equally affected), hemianesthesia, hemianopia, aphasia (DH), hemineglect or dressing apraxia (NDH)

• Upper division: hemiplegia (face/arm more affected than leg), hemianesthesia or hemianopia, Broca’s aphasia (DH) or spatial disorientation (NDH)

• Lower division: hemianopia, pure Wernicke’s aphasia (DH) or other intellectual deficits (NDH)

• Penetrating: pure contralateral hemiplegia or hemiparesis

• Cortical branches: monoparesis, discriminative and proprioceptive sensory loss, quadrantanopia, Broca’s aphasia, Gerstmann syndrome (DH), other intellectual deficits (NDH)⁴

What are the symptoms of vertebral artery occlusion?

Various combinations of ataxia, diplopia, vertigo, bulbar syndrome, and facial weakness

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