Cerebral infarction

Disease class: Brain infarction

Types

• dementia, Multi-infarct
• infarction, Anterior cerebral artery
• infarction, Middle cerebral artery
• infarction, Posterior cerebral artery

Brain stem infarctions

Disease class: Brain infarction

Subtypes

• Lateral medullary syndrome

Lacunar stroke

Disease class: Cerebral small vessel diseases
 Disease class: Stroke

Also known as

• Lacunar stroke 
• Lacunar infarct (LACI) 

This is a type of ischaemic stroke. It results from the occlusion of small penetrating arteries which provide blood to the brain's deep structures.

 

Etymology

C. Miller Fisher observed "lacunae" (empty spaces) in the deep brain structures after occlusion of 200–800 μm penetrating arteries and connected them with five classic syndromes.

 

Types

• Pure motor stroke / hemiparesis (occurs in 33–50%)
• Ataxic hemiparesis (second most frequent)
• Dysarthria / clumsy hand (sometimes considered a variant of ataxic hemiparesis)
• Pure sensory stroke
• Mixed sensorimotor stroke 
• Silent lacunar infarction. There are no symptoms despite a loss of brain tissue. This often considered to be a non-stroke syndrome because a diagnosis of stroke can be made clinically. However a diagnosis of silent lacunar infarction must be identified by radiological imaging or post-mortem examination.

 

Epidemiology

• It is estimated that lacunar infarcts account for 25% of all ischaemic strokes.
• There is an annual incidence of approximately 15 per 100,000 people. 
• They may be more frequent in men .
• They may be more frequent in people of African, Mexican, and Hong Kong Chinese descent.

Cerebral small vessel diseases

Disease class: Cerebrovascular disorders

Types

• CADASIL
• cerebral amyloid angiopathy, Familial
• Fabry disease
• MELAS syndrome
• Microscopic polyangiitis
• stroke, Lacunar

CHA2DS2-VASc

Also known as

• CHADS-VASc

Calculates stroke risk for patients with atrial fibrillation, possibly better than the CHADS₂ Score.

CHA2DS2-VASc Score	Stroke Risk %	95% CI
0	0	-
1	1.3	-
2	2.2	-
3	3.2	-
4	4.0	-
5	6.7	-
6	9.8	-
7	9.6	-
8	12.5	-
9	15.2	-

C 
 Congestive heart failure (or Left ventricular systolic dysfunction)
1 H
 Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication)
1 A₂
 Age ≥75 years
2 D
 Diabetes Mellitus
1 S₂
 Prior Stroke or TIA or thromboembolism
2 V
 Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque)
1 A
 Age 65–74 years
1 Sc
 Sex category (i.e. female sex)
1

Stroke medicine

Stroke specialists diagnose and manage stroke and 'stroke mimics'.
There is significant overlap with neurology, neurosurgery, psychiatry and vascular surgery. 

The three key points of management are:

• Stroke prevention
• Acute stroke
• Stroke rehabilitation

Relevant diseases:

• Cerebrovascular disorders

Apraxias

Disease class: Psychomotor disorders

Types

• Alien hand syndrome 
• apraxia, Ideomotor 
• Gait apraxia 

 

Definition

Apraxia, or dyspraxia, is the loss of ability to make accurate skilled movements. The cause is a disorder of the cerebral cortex of the brain: the patient is unable to coordinate his or her movements. Apraxia differs from clumsiness resulting from muscular weakness, loss of sensation or disease in the cerebellum. The condition is usually a consequence of disease in the brain’s parietal lobes, though frontallobe disease may cause it. A person with gait apraxia has normal power in the legs and no abnormal signs suggesting cerebellar disease, but cannot perform the normal act of walking because of malfunction in the cerebrum. 

Source: Black's Medical Dictionary (42nd ed, 2010, ISBN 978-1-4081-0419-4)

Brain infarction

Disease class: Brain ischaemia 

 Disease class: Stroke

Types

• Brain stem infarctions
• Cerebral infarction

 

See also

• If an infarction occurs in the heart : Myocardial infarction

QRISK

Current version: QRISK3

Estimates the 10-year cardiovascular risk of an individual.

 

Prognosis

A QRISK over 10 indicates a 10% risk of CVD event over the next ten years. This indicates that primary prevention with lipid lowering therapy (such as statins) should be considered.

 

See also

• Framingham Risk Score

Framingham Risk Score

Estimates the 10-year cardiovascular risk of an individual.

 

See also

• QRISK

Stroke

Disease class: Cerebrovascular disorders

Also known as

• Apoplexy 
• CVA
• Cerebrovascular accident 
• vascular accident, Brain 

 

Etymology

Stroke stands for "A stroke of apoplexy". αποπληξία(apoplēxía) = a strike from above.

 

Types

• Brain infarction 
• stroke, Lacunar 

 

Risk factors

• Diabetes mellitus
• Essential hypertension

Causes

• Hypertensive emergency