Neuroanatomy Stroke Syndromes Linking Imaging …...Neuroanatomy Stroke Syndromes Linking Imaging to...
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Neuroanatomy Stroke Syndromes Linking Imaging to Symptoms DR. WIESLAW OCZKOWSKI PROFESSOR, DEPARTMENT OF MEDICINE(NEUROLOGY) MEDICAL DIRECTOR REGIONAL STROKE PROGRAM MCMASTER UNIVERSITY, HAMILTON HEALTH SCIENCES
Transcript of Neuroanatomy Stroke Syndromes Linking Imaging …...Neuroanatomy Stroke Syndromes Linking Imaging to...
NeuroanatomyStrokeSyndromesLinkingImagingtoSymptoms
D R . W I E S L AW O C Z KOWS K I
P RO F E S S O R , D E PA R TM EN T O F M E D I C I N E ( N E U RO LOGY )
M E D I C A L D I R E C TO R R E G I ONA L S T RO K E P ROG R AM
MCMA S T E R U N I V E R S I T Y, H AM I LTON H E A LT H S C I E N C E S
None
DisclosuresandConflictsofInterest
Overviewoftheneurologicalassessment
Whyisissoimportantinstroke
Neurologicalsignsandimaging
Neurologicallocalizationwithcases
Objectives
Bill
72yearoldmale
§Hypertension
§Smoker
Strokecall:dizzy,facialdroop,slurredspeech
NeurologicalExam:
§Ptosisandmiosis onleft
§Numbleftface
§ Leftpalatalweakness
§Dysarthria
§Ataxicleftarmandleftleg
§Numbrightarmandleg
NIHStrokeScale
LOC:a,b,c_________________
Bestgaze__________________
Visualfields________________
Facialpalsy________________
Motorarmandleg__________
Limbataxia________________
Sensory_______________________
BestLanguage______________
Dysarthria_________________
Extinctionandinattention____§ (tone,reflexes,distalsensation,gait)
Score
0
0
0
0
0
2
1
0
1
0
-
-Left Ptosis
-Left miosis
-Weakness of
left palate
EKGofStroke
6
TroponinofStroke
8
It’s all about Stroke!
FocalMotororSensory
Presentation
Stroke NotStroke
AMeasuringandMonitoringNeurologicalExamination
LOC:a,b,c_________________
Bestgaze__________________
Visualfields________________
Facialpalsy________________
Motorarmandleg__________
Limbataxia________________
Sensory___________________
BestLanguage______________
Dysarthria_________________
Extinctionandinattention____§ (tone,reflexes,distalsensation,gait)
Score
Top - Down
Left - Right
Patient - Examiner
Hemispheres
Brainstem
Spinal Cord
Nerves
Muscles
Neuromuscular
Junction
Assess orientation (“How old are you?, What month is it?”)
Assesstheabilitytodescribethepicture
Assesstheabilitytoreadthesentences
Assessvisualfieldsandassessforinattention(4quadrants)
Assessthepupillarylightreflex
Assess eye movements following the “H” pattern
Assessfacialsensation(leftandrightcheekusingsharpanddull)
Assessfacialmovements(closeeyes,smile)
Assess palatal and tongue movements (say “ah”, stick out tongue)
Assesstoneinthe4limbsAssessstrengthusingdriftandarmrollingtests
Assessdistalsharp-dullandvibrationsensationandsensoryinattention
Assessreflexes(biceps,brachioradialis,triceps,quadriceps,AchillesandBabinski)
Assess limb coordination (finger to nose, heel – knee – shin)
Assessgaitandtandemwalking(tandemgait,normalgait)
TheNervousSystemisDistributed
AspectScoring
ASPECTSCORING
Roger57yearoldmale
◦ Atrialfibrillation
◦ CAD,CHF
◦ Pacemaker
◦ DM2
◦ HTN,DL
Presentedwithsuddenleftsidedweakness
Roger
Maria
66yearoldfemale
◦ HTN
◦ DL
◦ Depression
Foundathomeonthefloorunabletotalkandwithrightsidedweakness
Maria
Virginia91yearoldfemale
◦ Atrialflutter
◦ CHADS=1
Medications:ASA
Presentedwithsuddenonsetofinabilitytospeak
Virginia
Livia70yearoldfemale
◦ Hypertension
◦ Dyslipidemia
◦ Anxietyanddepression
Coronaryangiography
Postangiogramheadache
unabletosee
Livia
Christinia82yearoldfemale
◦ Hypertension
◦ Diabetes
◦ Dyslipidemia
Collapsewithsuddenrightlegweakness
Christina
Gladys85yearoldfemale
◦ Hypertension
◦ Dyslipidemia
FoundonthefloorwithadecreasedLOC
Slurredspeech,vomiting,andrightarmweakness
Gladys
Wayne68yearoldmale
◦ Atrialfibrillation
◦ PreviousTIA
◦ Hypertension
Hikingwithhiswife
Dizziness,lossofbalance,doublevision,leftweakness
Wayne
Complete ptosis
Eye laterally deviated
Greg31yearoldmale
◦ Well
Collapsed
BroughttoERwithleftweakness
Greg
Linda63female
◦ Previousstrokewith complete recovery
◦ Atrialfibrillation
◦ Diabetestype2
Presentedwithseveredysarthria,andleftweakness
Bill72yearoldmale
◦ Hypertension
◦ Smoker
Strokecall?
Bill
Left Ptosis
Left miosis
Weakness of left palate
Harry65yearoldmale
◦ Smoker
◦ COPD
Difficultywalking
Difficultybreathing
Admittedtostepdownandthenward
Unabletourinateandambulate
Harry
Sensory level at T4
NeuroanatomyStrokeSyndromesLinkingImagingtoSymptoms
D R . W I E S L AW O C Z KOWS K I
P RO F E S S O R , D E PA R TM EN T O F M E D I C I N E ( N E U RO LOGY )
M E D I C A L D I R E C TO R R E G I ONA L S T RO K E P ROG R AM
MCMA S T E R U N I V E R S I T Y, H AM I LTON H E A LT H S C I E N C E S
