Associated Neurological Findings

Cerebral. Patients with ischemic stroke or intracerebral hemorrhage may have a number of varied cortical deficits (.Tabie.2.2-2.). Patients should be evaluated for disturbances in attention, emotion, memory, and speech. Examination of higher cortical functions may be difficult acutely, but serial examinations are often helpful to detect the type and extent of cognitive disturbances.

A basic mental status examination should be performed, evaluating orientation, object recall, calculations, reading, writing, and comprehension. Patients should be examined for disturbances in spatial relationships including anosognosia, spatial disorientation, hemispacial neglect, constructional apraxia, and other apraxias that are seen with nondominant hemisphere lesions. Finger agnosia and right-left disorientation are seen with dominant hemispheric lesions. The typical deficits seen with the various stroke syndromes are detailedin T§ble...2,2,-2 .

Detailed classification of aphasia subtypes is helpful in localizing the area of stroke. There are typical findings with regard to fluency, comprehension, repetition, and naming with lesions in different locations (see Chapter^ ).

Cranial Nerves. Visual acuity should be checked with correction to evaluate for a decrement that can be seen with retinal vascular lesions. A dilated funduscopic examination may show evidence of retinal emboli. Visual fields examination may show a homonymous hemianopia that can be seen with middle cerebral artery, or posterior cerebral artery territory stroke or with posterior cerebral artery occlusion secondary to basilar artery disease. Bilateral homonymous

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TABLE 22-2 -- CLINICO-ANATOMICAL CORRELATION OF DISO

RDERS OF NEUROVASC

ULAR FUNCTION

Neurovascular

Cerebral

Cranial Nerves

Motor/Reflexes/ Cerebellar/Gait

Nervous

Diffuse hypoperfusion

GLOBAL ISCHEMIA

Diffuse hypoperfusion

Cerebral

Spinal cord

Extracranial steal syndrome

Carotid

Vertebrobasilar

Usually normal

Usually normal

Decreased radial pulse in affected arm

Carotid bruit, decreased carotid pulse, atherosclerosis

Vertebral or basilar bruit

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