Clinical Symptoms of Ischemic Stroke

Clinical Symptoms of Ischemic Stroke medical treatment and therapy
        Clinical symptoms of ischemic stroke can occur at different locations depending on the neuroanatomical and vascularization were attacked, among others:

1. Anterior cerebral artery
         Anterior cerebral artery is an artery that provides blood supply to an area of the cerebral cortex parasagital, which includes motor and sensory cortex area for the contralateral limb, is also the center of inhibitoris bladder (micturition center). 
Symptoms that may arise if the disruption of the anterior cerebral blood flow was contralateral paralysis and sensory disturbances of the lower limbs. Furthermore, it can also be found disruption due to failure of control micturition reflex inhibition of contractions in the bladder, with impacts that are happening presipitatif micturition.
2. Middle cerebral artery
         Cerebral artery is an artery that supplies to most of the cerebral hemispheres and in subcortical structures, which cover an area of cortical division superior, inferior, and lenticulostriate. Symptoms that may arise if the superior cortical divisions that give rise to contralateral hemisensory with similar distribution, but without hemianopia homonimus. If the affected hemisphere is dominant side, symptoms may also be accompanied by Brocca aphasia (expressive aphasia), which has a characteristic form of language expression disorder. Symptoms in inferior cortical division rarely attacked in isolation, can be homonimus contralateral hemianopia, cortical sensory dysfunction, such graphestesia, stereonogsia contralateral, impaired spatial understanding, anosognosia, impaired identification of the contralateral limb, and apraxia. In lesions of the dominant side, it will happen anyway Wernicke aphasia (receptive aphasia).
        When a stroke occurs due to occlusion in the bifurcation or trifurcation (middle cerebral artery branching locations) which is the base of the superior and inferior divisions, there will be a severe stroke. Thus, it will happen and hemisensory contralateral hemiparesis, which involve the face and arm more than the leg, going homonimus hemianopia, and if the dominant side will be global aphasia (perceptive and expressive).
       Occlusion occurs at the base of the middle cerebral artery blood flow would lead to a halt and will branch lenticulostriate get more powerful stroke. As a result, in addition to joint symptoms or occlusion in bifurcatio trifurcatio as mentioned above, also will get symptoms of paralysis of the contralateral leg.

3. Internal carotid artery

        Internal carotid artery is an artery that originate on the end of the common carotid artery divides in two. Internal carotid artery branches into the anterior cerebral artery and the media, as well as a oftalmikus arteries that provide blood supply to the retina. The severity of symptoms caused by occlusion of the internal carotid artery is determined by the existing collateral flow. Approximately 15% of ischemic stroke caused by occlusion of the internal carotid artery will be preceded by a TIA symptoms or symptoms of monocular visual impairment is temporary, that the retina of the eye ipsilateral side.
        Overall, the symptoms is a combination of the middle cerebral artery occlusion and anterior plus symptoms of arterial occlusion oftalmikus emerging as hemiplegia and contralateral hemisensoriy, aphasia, hemianopia homonimus and ipsilateral visual impairment.

4. Posterior cerebral artery
         Posterior cerebral artery is a branch of the basilar artery that provides blood flow to the cerebral occipital cortex, medial temporal lobe, thalamus, and rostral part of the mesencephalon. Embolism originating from the basilar arteries can clog arteries.
         Symptoms that arise in case of occlusion of the posterior cerebral artery causing hemianopia homonimus that the contralateral field of view. While occlusion occurs at the beginning of the posterior cerebral artery on mesensefalon will provide a vertical view of the symptoms of paralysis, cranial nerve disorders oculomotory, oftalmoplagia internuclear and vertical defiation drai eyeball.
      If occlusion of the occipital lobe of the dominant hemisphere, can occur anomic aphasia (difficulty naming objects), alexia without agraphia (can not be read without difficulty writing), visual agnosia (inability to identify objects that are on the left), and as a result of lesions in the corpus callosum causes, broken relationship, the right visual cortex and language areas in the left hemisphere. Second occlusion of the posterior cerebral artery (right and left) resulted in patients experiencing cortical blindness, impaired memory and Prosopagnosia (inability to recognize faces is already known).

5. Basilar Artery
      Basilar artery is a combination of a pair of vertebral artery. Branches of the basilar artery providing blood supply to the occipital lobe, temporal lobe media, media thalamus, internal capsule posterior crucible, brain stem and cerebellum.
        Symptoms arise due to occlusion of the basilar artery thrombus causing neurological deficits with bilateral involvement of several arterial branches. Basilar thrombosis affects the proximal portion of the basilar artery that delivers blood to the pons. The involvement of the dorsal pons resulting horizontal eye movement disorders, the vertical nigtagmus, and other ocular movements such as the reactive pupil constriction, which is often accompanied hemiplegi coma and basilar occlusive syndrome with loss of consciousness.
         Embolism from vertebral artery distal basilar artery clogging resulting in decreased blood flow in the ascending reticular formation and thalamus mesencephalon causing loss of consciousness. Whereas smaller embolism may clog more rostral and in such cases, mesencephalon, thalamus, temporal lobe and occipital infarction may experience. This condition can lead to visual disturbances (homonymous hemianopia, cortical blindness), visiomotor (convergent movement disorders, paralysis of vertical vision, diplopia), and behavior (especially disorientation) without abnormal motor disorders.

6. Branch vertebrobasilar circumferential

        Circumferential branches of the vertebral artery and the basilar artery is cerebralis posterior inferior, anterior inferior cerebral and superior cerebral.
         Symptoms caused by posterior inferior cerebral artery occlusion resulted in lateral medullary syndrome (Wallenberg's syndrome). This syndrome can be accompanied by ipsilateral cerebral ataxia, Horner's syndrome, facial sensory defisif, hemihipertesi alternan, nystagmus, vertigo, nausea, vomiting, dysphagia, dysarthria, and hiccups. Anterior inferior cerebral artery occlusion would result in infarction of the lateral side of the caudal pons and cause the clinical syndrome such as facial muscle paresis, paralysis sight, deafness, and tinnitus. Superior cerebral artery occlusion would result in lateral rostral pontine syndrome-like lesions accompanied by the optokinetic nystagmus or skew deviation.

7. Branch vertebrobasilar paramedian
        Paramedian artery branches provide blood flow from the medial side of the brain stem to the base of the ventral surface of the fourth ventricle. Structure in this region include the medial side pedunkulus cerebri, sensory pathways, rubra nuclei, reticular formation, cranial nuclei (N.III, N. IV, N.VI, N.XII).
      Symptoms caused by arterial occlusion depends where occlusion occurs. Occlusion of the mesencephalon cause paresis nerve  oculomotor (N.III) with ipsilateral ataxia. Abdusen nerve paresis (N.VI) and the facial nerve (N.VII) ipsilateral lesions occur in the pons, is hipoglosus nerve paresis (N.XII) occurs when the lesion as high as the medulla oblongata. Clinical manifestations may include coma when the lesion involves both sides of the brain stem.

8. Branches of the vertebrobasilar basalis

          Branching is derived from circumferential arteries entering the brain stem and gave vertebral blood flow brainstem motor pathways. Symptoms are caused by occlusion of the basilar artery contralateral hemiparesis, and cranial nerve if (N.III, N.VI, N.VII) exposure occurs ipsilateral cranial nerve paresis.

9. Lacunar Infarction
        Lacunar infarction often occurs in the nucleus of the brain (putamen 37%, 14% thalamus, caudate nucleus of 10%, 26% pons, internal capsule posterior crucible 10%). There are 4 kinds of lacunar infarction syndrome are pure hemiparesis, pure sensory stroke, ataxic hemiparesis, and dysarthria-clumsy hand syndrome.

•    Types of Stroke
•    Ischemic Stroke
•    Post-Acute Phase Therapy of Stroke


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