Area 51:Stroke Syndromes
In this syndrome patients can only move their eyes vertically or blink.
Locked-in Syndrome
2/2 bilateral lesions of the vertebral pons, basilar artery occlusion. Conscious due to sparing of the reticular activating system (RAS)
The best evidence to anticoagulate someone is presence of...
Cardiac emboli
Spasticity peaks during this Brunnstrom stage?
Stage 3
This medication decreases cerebral vasospasms after SAH and improves outcomes.
Nimodipine
CCB, 60mg PO q4h x 21days. Also has been shown to decrease the incidence of permanent neurologic damage and death.
This standardized scale measures independence in activities of daily living and is commonly used to track functional recovery in stroke patients.
Barthel Index
The artery involved in this stroke syndrome. Decrease in pain and temperature on the ipsilateral face and contralateral body. Dysphagia, dysarthria, hoarseness, nystagmus, and diplopia.
Vertebral Artery. This is Wallenberg (Lateral Medullary) syndrome.
Other arteries include PICA, Superior lateral medullary artery, middle lateral medullary artery, inferior lateral medullary artery
IV labetalol is the agent of choice in managing BP in hemorrhage strokes for this reason.
It does not cause cerebral vasodilation. We care because this would worsen ICP.
Keep ICP <20mmg. Normal is 2-5mmhg.
Passive ROM becomes difficult at this MAS level
3
Drug class with the best evidence for efficacy in treating post-traumatic agitation
Beta blockers- Propranolol
A post-stroke patient demonstrates severe left-sided hemiparesis. You want to predict upper-limb recovery potential. Which early clinical sign is the best predictor of functional recovery?
Motor recovery of the hand by 4 weeks
There is up to 70% change of making a full or good recovery
The syndrome that causes ipsilateral CN3 nerve paralysis with mydriasis, contralateral hypesthesia and hyperkinesia.
Benedikt Syndrome
Neurologic deficits are present are this stage of the Hunt and Hess Scale.
Stage 3
There are 4 FDA-approved medications for the management of spasticity of CNS disorder: Baclofen, Tizanidine, ____ and ____.
Dantrolene, and Diazepam
Lab that needs to be ordered in patients prescribed carbamazepine
CBC - to monitor for agranulocytosis
Every 2 to 4 months
GCS: Patient says stop pinching my arm, states president is Obama, and looks around the room trying to figure out where he is.
13
The syndrome that causes CN VI and CN VII palsies, conjugate gaze palsy and hemisensory loss.
Raymond-Foville Syndrome
Lesions in the ipsilateral paramedian pontine reticular formation (PPRF) and medial longitudinal fasciculus (MLF) lead to conjugate side.
Millard-Gubler Syndrome: CN VI and CN VII + contralateral hemiplegia.
Raymond–Foville = “Roving eyes are Frozen”
Name the indication for carotid endarterectomy
70% or greater stenosis in a symptomatic lesion
Name the two procedures done for addressing pain caused by a MAS of 4 in the plantarflexors
SPLATT (Split Anterior Tibial Tendon Transfer) and achilles tendon lengthening
First line treatment for early PTS.
Levetiracetam (Keppra)
Favorable side effect profile and comparable efficacy relative to phenytoin.
This is a rare complication following craniectomy characterized by delayed sensorimotor or cognitive worsening associated with headache, dizziness, fatigue, and pain at craniectomy site.
Syndrome of Trephined
"Sunken flap syndrome"
Dysarthria/ “Clumsy hand syndrome” is due to an infarct in this location.
Basis pontis or anterior limb of the internal capsule
The diagnostic criteria for Complex Regional Pain Syndrome (CRPS) includes which four categories.
Sensory, Vasomotor, Sudomotor/edema, and Motor/trophic.
The Tardieu Scale assesses spasticity by measuring these two key features during passive stretch.
Stretch velocity and the joint angle of muscle reaction
Helps distinguish true neural overactivity from fixed contracture.
Name the pathway with Decreased dopamine, and increased negative symptoms.
Mesocortical pathway
The symptoms of this complication include diplopia, tearing, red eye, headache, proptosis, and subjective ocular bruit.
Carotid-Cavernous fistula
Direction connection frequently caused by trauma between internal carotid artery and cavernous sinus.
Tx: endovascular embolization of fistula