Ischemic Strokes

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Associated Articles
Swell Watch (Malignant Cerebral Edema)

FACTS

  • ~85% of strokes are ischemic (~15% hemorrhaghic)
  • Thresholds of cerebral ischemia:
    • gray matter: ~100 mL blood/100g tissue
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HPI

 

PHYSICAL EXAM

IMAGING

MRI DWI:
  • mechanism of diffusion restriction in strokes - water moves intracellularly (as opposed to interstitial space) → constrained space → reduced brownian motion → bright on diffusion restriction
MR Spectroscopy: lactate and lipid peaks increase
A/P

Stroke Syndromes

Weber Syndrome

Location: cerebral peduncle, ipsilateral fasicles of oculomotor nerve
Symptoms: diplopia, ptosis, afferent pupillary defect, contralateral hemiplegia/hemiparesis, parkinsonian rigidity
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Wallenberg Syndrome

  • vertigo with nystagmus (inferior vestibular nucelus and pathways)
  • Ipsilateral Horner’s (sympathetic fibers)
  • contralateral pain/temperature loss (spinothalamic tract)
  • dysphonia/dysphagia/dysarthria (different nuclei and fibers of CN 9/10)
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