STROKE AND ITS

CLASSIFICATION ON THE BASIS

OF AREAS
Presented by Taskeen zafar
Stroke

Stroke (cerebrovascular accident [CVA]) is the

sudden loss of neurological function caused by
an interruption of the blood flow to the brain.
Etiology
Atherosclerosis is a major contributory factor in
cerebrovascular disease. It is characterized by
plaque formation with an accumulation of
lipids, fibrin, complex carbohydrates, and
calcium deposits on arterial walls that leads to
progressive narrowing of blood vessels.
continue...
Interruption of blood flow by atherosclerotic
plaques occurs at certain sites of predilection.
hese generally include bifurcations,
constrictions, dilations, or angulations of
arteries. The most common sites for lesions to
occur are at the origin of the common carotid
artery or at its transition into the middle
cerebral artery, at the main bifurcation of the
middle cerebral artery, and at the junction of
the vertebral arteries with the basilar artery.
Stroke manifestation on the basis of
area involved
 The manifestation of a stroke will depend
on many factors. When a stroke occurs,
areas of the brain are deprived of their
oxygen supply, causing necrosis of cerebral
tissue and resulting in neurological deficits.
 The deficits that may present will depend

on the area of the brain involved

Stroke Classification on the basis of
Area
 Cortical stroke( ACA, MCA, PCA stroke)
 Subcortical stroke( Lacunar stroke)
 Brain stem stroke
LEFT AND RIGHT HEMISPHERE
STROKE
 When a stroke occurs, it is important to take
note of which brain hemisphere it has
occurred in, as this will suggest the
neurological deficits that have potentially
occurred.
 Generally, the patient will experience

hemiplegia on the opposite side of the area

of stroke. For example, if they had a stroke in
the left hemisphere of their brain, they will
experience right-sided weakness or
hemiplegia
Blood supply of Brain
Blood supply of cerebrum
 Extracranial blood supply to the brain is
provided by the right and left internal carotid
arteries and by the right and left vertebral
arteries.
 Posterior circulation is from vertebral artery

and anterior circulation is from internal

carotid artery.They both give branches and
anastomose at circle of willis.
MIDDLE CEREBRAL ARTERY
The middle cerebral artery (MCA) is the second
of the two main branches of the internal carotid
artery and supplies the entire lateral aspect of
the cerebral hemisphere (frontal,temporal, and
parietal lobes) and subcortical structures,
including the internal capsule (posterior
portion), corona radiata, globus pallidus (outer
part), most of the caudatenucleus, and the
putamen.
 MIDDLE CEREBRAL ARTEY
SYNDROME
 Deficits in movement and sensation
(contralateral hemiplegia and
hemianesthesia);
 Difficulty swallowing (dysphagia);
 Impaired speech ability (dysarthria, aphasia);
 Impaired vision and partial blindness

(hemianopia);
 Headaches; and
 Hemineglect.
Anterior Cerebral Artery
The anterior cerebral artery (ACA) is the first
and smaller of two terminal branches of the
internal carotid artery.
It supplies the medial aspect of the cerebral
hemisphere (frontal and parietal lobes) and
subcortical structures,including the basal
ganglia (anterior internal capsule, inferior
caudate nucleus), anterior fornix, and anterior
four-fifths of the corpus callosum.
Anterior Cerebral Artery syndrome
 The deficits left following this type of stroke may
include:
 Deficits in movement and sensation (contralateral
hemiplegia and hemianesthesia) that are often
worse in the lower limbs;
 Gait apraxia;
 Disinhibition and speech perseveration;
 Reduction in speech, motivation or movement
(abulia); and
 Mental state impairments such as confusion,
amnesia, apathy, short attention span.
Posterior Cerebral Artery
The two posterior cerebral arteries (PCAs) arise
as terminal branches of the basilar artery and
each supplies the corresponding occipital lobe
and medial and inferior temporal lobe. It also
supplies the upper brainstem,midbrain, and
posterior diencephalon, including most of the
thalamus.
POSTERIOR CEREBRAL ARTERY
SYNDROME
 Occlusion proximal to the posterior communicating artery typicall y
results in minimal deficits owing to the collateral blood supply from
the posterior communicating artery (similar to ACA syndrome).

 Occlusion of thalamic branches may produce hemianesthesia

(contralateral sensory loss) or central post-stroke (thalamic) pain.
 Occipital infarction produces homonymous hemianopsia, visual
agnosia,prosopagnosia, or, if bilateral, cortical blindness.
 Temporal lobe ischemia results in amnesia (memory loss).
Involvement of subthalamic branches may involve the subthalamic
nucleus or its pallidal connections, producing a wide variety of
deficits.
 Contralateral hemiplegia occurs with involvement of the cerebral
peduncle.
Subcortical areas stroke
Lacunar stroke
Lacunar strokes are caused by small vessel
disease deep in the cerebral white matter
(penetrating artery disease)They are strongly
associated with hypertensive hemorrhage and
diabetic microvascular disease.
cont...
Lacunar syndromes are consistent with specific
anatomical sites.
pure motor lacunar stroke is associated with
involvement of the posterior limb of the internal
capsule, pons, and pyramids.
Pure sensory lacunar stroke is associated with
involvement of the ventrolateral thalamus or
thalamocortical projections
BRAIN STEM STROKE
Features
 Crossed findings
 Deficit in face is ipsilateral and deficit in body

is controlateral.
 Cranial nerves involve
 Motor and sensory pathways travel cross

down Nd cranial nerves exit in brain the same

way it travels..
Types
 Medial medullary syndrome
 Lateral medullary syndrome
 Medial pontine syndrome
 Lateral pontine syndrome
Medial medullary syndrome
 Anterior spinal artery is involved
 Cranial nerves 9-12 involved
 Ipsilateral flaccid paralysis of tongue
 Controlateral loss of TVP( tactile,

vibration,pressure).
Lateral medullary syndrome
 PICA is involved
 Ipsilateral horner syndrome
 Ataxia
 Ipsilateral nystigmus
 Ipsilateral loss of pain and temprature
 Also called as wallen berg syndrome
Medial pontine syndrome
 Also called as "locked in" syndrome.
 Basilar artery is involved
 Facial and abducen nerves involved medial

eye devaited
 Ipsilateral facial and abducen nerve palsy
Lateral pontine syndrome
 AICA is involved
 Symptoms same as lareral medullary

syndrome..
 Ipsilateral trigemminal nerve palsy.
Thank you