Neuroanatomy Stroke Syndromes Linking Imaging to Symptoms D R . - PowerPoint PPT Presentation

Neuroanatomy Stroke Syndromes Linking Imaging to Symptoms D R . W I E S L AW O C Z KO W S K I P R O F E S S O R , D E PA R T M E N T O F M E D I C I N E ( N E U R O L O G Y ) M E D I C A L D I R E C T O R R E G I O N A L S T R O K E P R O G R A M M C M A S T E R U N I V E R S I T Y, H A M I LT O N H E A LT H S C I E N C E S

Disclosures and Conflicts of Interest None

Objectives Overview of the neurological assessment Why is is so important in stroke Neurological signs and imaging Neurological localization with cases

Bill 72 year old male § Hypertension § Smoker Stroke call: dizzy, facial droop, slurred speech Neurological Exam: § Ptosis and miosis on left § Numb left face § Left palatal weakness § Dysarthria § Ataxic left arm and left leg § Numb right arm and leg

NIH Stroke Scale Score LOC: a,b,c_________________ 0 Best gaze__________________ 0 Visual fields________________ 0 Facial palsy________________ 0 Motor arm and leg__________ 0 -Left Ptosis Limb ataxia________________ 2 -Left miosis Sensory _______________________ -Weakness of 1 left palate Best Language______________ 0 Dysarthria_________________ 1 Extinction and inattention____ 0 § (tone, reflexes, distal sensation, gait) -

EKG of Stroke 6

Troponin of Stroke 8

It’s all about Stroke! Focal Motor or Sensory Presentation Stroke Not Stroke

A Measuring and Monitoring Score Neurological Examination LOC: a,b,c_________________ Best gaze__________________ Visual fields________________ Facial palsy________________ Motor arm and leg__________ Limb ataxia________________ Sensory___________________ Best Language______________ Dysarthria_________________ Extinction and inattention____ § (tone, reflexes, distal sensation, gait)

Top - Down Left - Right Patient - Examiner

Hemispheres Brainstem Spinal Cord Nerves Muscles Neuromuscular Junction

Assess orientation (“How old are you?, What month is it?”)

Assess the ability to describe the picture

Assess the ability to read the sentences

Assess visual fields and assess for inattention (4 quadrants)

Assess the pupillary light reflex

Assess eye movements following the “H” pattern

Assess facial sensation (left and right cheek using sharp and dull)

Assess facial movements (close eyes, smile)

Assess palatal and tongue movements (say “ah”, stick out tongue)

Assess tone in the 4 limbs Assess strength using drift and arm rolling tests

Assess distal sharp-dull and vibration sensation and sensory inattention

Assess reflexes (biceps, brachioradialis, triceps, quadriceps, Achilles and Babinski)

Assess limb coordination (finger to nose, heel – knee – shin)

Assess gait and tandem walking (tandem gait, normal gait)

The Nervous System is Distributed

Aspect Scoring

ASPECT SCORING

Roger 57 year old male ◦ Atrial fibrillation ◦ CAD, CHF ◦ Pacemaker ◦ DM2 ◦ HTN, DL Presented with sudden left sided weakness

Roger

Maria 66 year old female ◦ HTN ◦ DL ◦ Depression Found at home on the floor unable to talk and with right sided weakness

Maria

Virginia 91 year old female ◦ Atrial flutter ◦ CHADS = 1 Medications: ASA Presented with sudden onset of inability to speak

Virginia

Livia 70 year old female ◦ Hypertension ◦ Dyslipidemia ◦ Anxiety and depression Coronary angiography Post angiogram headache � unable to see �

Livia

Christinia 82 year old female ◦ Hypertension ◦ Diabetes ◦ Dyslipidemia Collapse with sudden right leg weakness

Christina

Gladys 85 year old female ◦ Hypertension ◦ Dyslipidemia Found on the floor with a decreased LOC Slurred speech, vomiting, and right arm weakness

Gladys

Wayne 68 year old male ◦ Atrial fibrillation ◦ Previous TIA ◦ Hypertension Hiking with his wife Dizziness, loss of balance, double vision, left weakness

Wayne Complete ptosis Eye laterally deviated

Greg 31 year old male ◦ Well Collapsed Brought to ER with left weakness

Greg

Linda 63 female ◦ Previous stroke with � complete � recovery ◦ Atrial fibrillation ◦ Diabetes type 2 Presented with severe dysarthria, and left weakness

Bill 72 year old male ◦ Hypertension ◦ Smoker Stroke call?

Bill Left Ptosis Left miosis Weakness of left palate

Harry 65 year old male ◦ Smoker ◦ COPD Difficulty walking Difficulty breathing Admitted to stepdown and then ward Unable to urinate and ambulate

Harry Sensory level at T4

Neuroanatomy Stroke Syndromes Linking Imaging to Symptoms D R . W I E S L AW O C Z KO W S K I P R O F E S S O R , D E PA R T M E N T O F M E D I C I N E ( N E U R O L O G Y ) M E D I C A L D I R E C T O R R E G I O N A L S T R O K E P R O G R A M M C M A S T E R U N I V E R S I T Y, H A M I LT O N H E A LT H S C I E N C E S