Impairments after Stroke

• Patients with left-sided strokes will have right-sided deficits. They will be cautious, anxious, and organized.
• Patients with left sided strokes will be easily frustrated, indicating they will need more feedback and support.
• Patients with left-sided strokes will have speech and language deficits.
• Patients with right side strokes will be impulsive and not use good judgement.
• It is important to consider safety often with patients who had right sided strokes.
• Anterior circulation strokes occur with ACA and MCA strokes.
• Posterior circulation strokes are PICA or VA strokes.
• The anterior cerebral artery supplies the superior border of the frontal and parietal lobes.
• Deficits after ACA strokes include contralateral deficits, mostly in the lower extremity, urinary incontinence, aphasia, and apraxia.
• Common ACA deficits include personality changes, profound abulia, and rarely akinetic mutism.
• Perserverations are continued repetition of words, thoughts, or acts without any relationship to current context.
• Profound abulia is the absence of willpower or decisiveness.
• Patients with akinetic mutism are alert, but unable to or unmotivated to move or talk.
• MCA strokes are the most common.
• The MCA supplies the surface of the cerebral hemispheres and the deep frontal and parietal lbes.
• MCA strokes will lead to contralateral deficits in the upper extremity and face.
• MCA strokes will lead to homonymous hemianopsia, aphasia, and perceptual deficits.
• Homonymous hemianopsia occurs when the patient loses one complete side of the visual field.
• After MCA stroke, perceptual deficits typically occur on the right side.
• MCA strokes will lead to aphasia.
• Wernicke's aphasia is also known as receptive. The patient will have normal speech, but will have impaired auditory comprehension.
• Broca's aphasia is also known as expressive. The patient has difficulty with speaking fluently or understanding written language.
• Global aphasia is characterized by both Broca's and Wernicke's symptoms.
• Dysarthria is poor articulation.
• Dysphagia is difficulty swallowing.
• If the patient is in side-lying on the involved side, the involved upper extremity must be protracted and forward.
• The ICA supplies both the MCA and ACA. ICA strokes will lead to massive impairments, or death.
• The PCA supplies the occipital and temporal lobes, thalamus, and upper brain stem.
• PCA strokes will lead to visual deficits, involuntary movements, and thalamic pain syndrome.
• Thalamic pain syndrome is a possibility with any stroke that affects the lateral thalamus.
• In thalamic pain syndrome, any sensory cue will hurt or burn.
• Pusher syndrome occurs with strokes that affect the posterolateral thalamus.
• In pushers syndrome, there is a mismatch between the patient's perception of vertical and the body's orientation to the environment.
• In pusher's syndrome, the patient will be tilted 18-20 degrees toward the hemiparetic side.
• Pusher's syndrome typically indicates longer recovery and potentially worse outcomes.
• Lacunar vessels are small vessels found deep in white matter.
• Lacunar infarcts will lead to contralateral weakness and sensory loss, ataxia, and dysarthria.
• Vertebral arteries supply the cerebellum via the PICA and the medulla via the medullary arteries.
• The basilar artery supplies the pons, internal ear, cerebellum and medulla.
• Vertebrobasilar artery strokes lead to a wide variety of symptoms. They will almost always have cranial nerve involvement.