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

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

Feb 11, 2023 113 likes •837 views

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

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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

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None

Disclosures and Conflicts of Interest

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

Objectives

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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

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NIH Stroke Scale

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)

Score 2 1 1

  • Left Ptosis
  • Left miosis
  • Weakness of

left palate

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EKG of Stroke

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Troponin of Stroke

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It’s all about Stroke!

Focal Motor or Sensory Presentation

Stroke Not Stroke

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A Measuring and Monitoring 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)

Score

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Top - Down Left - Right Patient - Examiner

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Hemispheres Brainstem Spinal Cord Nerves Muscles Neuromuscular Junction

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

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Assess the ability to describe the picture

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Assess the ability to read the sentences

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Assess visual fields and assess for inattention (4 quadrants)

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Assess the pupillary light reflex

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Assess eye movements following the “H” pattern

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

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Assess facial movements (close eyes, smile)

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

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

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Assess distal sharp-dull and vibration sensation and sensory inattention

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

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

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

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The Nervous System is Distributed

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Aspect Scoring

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ASPECT SCORING

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Roger

57 year old male

  • Atrial fibrillation
  • CAD, CHF
  • Pacemaker
  • DM2
  • HTN, DL

Presented with sudden left sided weakness

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Roger

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Maria

66 year old female

  • HTN
  • DL
  • Depression

Found at home on the floor unable to talk and with right sided weakness

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Maria

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Virginia

91 year old female

  • Atrial flutter
  • CHADS = 1

Medications: ASA Presented with sudden onset of inability to speak

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Virginia

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Livia

70 year old female

  • Hypertension
  • Dyslipidemia
  • Anxiety and depression

Coronary angiography Post angiogram headache unable to see

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Livia

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Christinia

82 year old female

  • Hypertension
  • Diabetes
  • Dyslipidemia

Collapse with sudden right leg weakness

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Christina

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Gladys

85 year old female

  • Hypertension
  • Dyslipidemia

Found on the floor with a decreased LOC Slurred speech, vomiting, and right arm weakness

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Gladys

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Wayne

68 year old male

  • Atrial fibrillation
  • Previous TIA
  • Hypertension

Hiking with his wife Dizziness, loss of balance, double vision, left weakness

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Wayne

Complete ptosis Eye laterally deviated

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Greg

31 year old male

  • Well

Collapsed Brought to ER with left weakness

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Greg

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Linda

63 female

  • Previous stroke with complete recovery
  • Atrial fibrillation
  • Diabetes type 2

Presented with severe dysarthria, and left weakness

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Bill

72 year old male

  • Hypertension
  • Smoker

Stroke call?

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Bill

Left Ptosis Left miosis Weakness of left palate

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Harry

65 year old male

  • Smoker
  • COPD

Difficulty walking Difficulty breathing Admitted to stepdown and then ward Unable to urinate and ambulate

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Harry

Sensory level at T4

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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