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Clinical Presentation in Relation to Anatomy Involved In a Stroke

Alaena McCool, MS, OTR/L, CPAM, Katherine George, PT, DPT

March 15, 2023

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Question

Can you elaborate on the common clinical presentations seen with specific arteries affected in a stroke?  

Answer

Let's review some definitions first so we are all on the same page. Ischemic strokes are due to an obstruction in the vasculature preventing the brain tissue from getting oxygen and nutrients. These obstructions can include blood clots or fatty buildup.

Hemorrhagic strokes are due to blood vessel rupture or leakage causing blood flow into the brain tissue, which causes cell death. This can be due to aneurysms or weakness in the vessel wall, uncontrolled hypertension, and the overuse of medications like anticoagulants. Per Tsao et al., 2022, Eighty-seven percent of all strokes are ischemic, and 13% are hemorrhagic. Hemorrhagic strokes are more severe and have worse outcomes than ischemic ones. 

Most clinical presentations do not fit into a nice little box, as with all neurological conditions. It is nice to have basic knowledge about what to expect to help guide your evaluation process and decision-making.

 

Posterior Cerebral Artery (PCA)

•Branches from the basilar artery

•Supplies occipital and temporal lobes, thalamus

•Visual deficits

•Contralateral strength and sensory loss

•Aphasia with L PCA strokes

•Neglect with R PCA strokes

Vertebral Arteries/ Basilar Artery

•Vertebral arteries join to form the basilar artery

•Supplies the posterior portion of the brain, including the cerebellum and brainstem

•Vertigo, visual deficits, speech deficits, balance and coordination deficits, including ataxia with cerebellar strokes

•Strength, sensation, vision, swallowing, breathing, and arousal deficits with brain stem strokes

Middle Cerebral Artery (MCA) 

•Largest vessel branching from the internal carotid artery

• Supplying large areas of the frontal/temporal/ parietal lobes and basal ganglia 

•Contralateral strength and sensory loss in face/arms > legs

•Contralateral homonymous hemianopia •Aphasia with L sided MCA strokes •Neglect with R sided MCA strokes

Anterior Cerebral Artery (ACA)

•Branching from the internal carotid artery

•Supplies portions of the frontal and parietal lobes

•Contralateral strength and sensory loss in legs > arms

•Confusion, delayed response times, memory deficits

•Apraxia possible

 

This Ask the Expert is an edited excerpt from the course, 4607 Interdisciplinary Approach To Stroke Rehabilitation: Acute Care And Inpatient Rehabilitation Phase by Alaena McCool, MS, OTR/L, CPAM and Katherine George, PT, DPT.

 

 


alaena mccool

Alaena McCool, MS, OTR/L, CPAM

Alaena McCool is an occupational therapist at Kennedy Krieger Institute working within the International Center for Spinal Cord Injury. Alaena graduated from the University of Pittsburgh in 2011 with a Bachelor of Arts Degree in Communication Science. She went on to pursue a Master's Degree in Occupational Therapy from New York University, graduating in 2015. Alaena specializes in the neurological population and has a special interest in spinal cord injury with adults and pediatrics.


katherine george

Katherine George, PT, DPT

Katherine (Katie) George graduated from the University of Albany in 2010 with a Bachelor of Science Degree in Human Biology and a Bachelor of Arts Degree in Psychology. She completed her graduate work at Columbia University, graduating in 2013 with a Doctorate of Physical Therapy degree. Katie has experience working with pediatric, adult, and geriatric patients in acute care and acute rehabilitation settings. Katie specializes in the neurological population, specifically with stroke and traumatic brain injury patients.


Related Courses

Interdisciplinary Approach To Stroke Rehabilitation: Acute Care And Inpatient Rehabilitation Phase
Presented by Alaena McCool, MS, OTR/L, CPAM, Katherine George, PT, DPT
Recorded Webinar

Presenters

Alaena McCool, MS, OTR/L, CPAMKatherine George, PT, DPT
Course: #4607Level: Intermediate2 Hours
  'Carryover from acute care setting to inpatient rehab'   Read Reviews
The unique collaboration and relationship between physical and occupational therapists throughout the evaluation and treatment of acute, subacute, and chronic stroke diagnoses will be analyzed in this two-part series. Part one will distinguish important stroke definitions used within the medical field and compare and contrast the differences between the acute and inpatient rehabilitation phases.

Interdisciplinary Approach To Stroke Rehabilitation: Outpatient, Home Health, And Community Rehabilitation Phase
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The unique relationship between the occupational and physical therapist when treating an acute, subacute, or chronic stroke diagnosis will be distinguished in this two-part series. Part two will focus on the subacute and chronic stroke, differentiating the home, outpatient, and community phases of rehabilitation, as well as examining the evaluation, evidence, and interventions in each setting to optimize independence for the patient.

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