*Hemorrhagic Stroke

• 2 basic AREAS with their own subtypes of ruptures
  --> SAH = congenital Berry aneurism ruptures
  --> intraparenchymal DEEP ruptures of C-B aneurisms of LSA and CAA angiopathy
  

*SAH - Hemorrhagic Stroke

• SAH = congenital Berry aneurism ruptures
  -->

*Intraparenchymal DEEP - Hemorrhagic Stroke

• 2 basic ruptures in IPH
• ruptures of Charcot-Bouchard anurisms of lenticulostriate artery
• DEEP CAA = cerebral amyloid angiopathy
  plaques that suddenly rupture
  

*Brain Aneurisms

• rupture causes 2 types of hemorrhage depending on location of the aneurism
  --> SAH = congenital Berry aneurism ruptures
  --> intraparenchymal DEEP ruptures = C-B aneurisms

*Recovery of Stroke timeline

• different stages of inflammatory cells in the brain repairing damage from stroke
  --> days <1, 1-3, 3-5, 1 week, 2 weeks
• eosinophils, then neutraphils, then macrophages
  --> week 1 = gliosis and vascular proliferation
  --> week 2 = glial scars fully formed

*Lacunar Stroke

• biggest risk factors = uncontrolled HTN and diabetes
  --> smoking also
• most common type of ISCHEMIC stroke
• "lacunar" refers to LAKES of fluid that form after cells have been damaged
  --> these lakes are from ischemia led necrosis and edema
• most are in the second segment of the middle cerebral artery
  --> deep in the brain at the basal ganglia
  --> most common = lenticulostriate artery to BG

*Global Ischemia

• Global Ischemia affects illegally parked cars FIRST
• "CAN'T PARK NEAR here"
  --> Caudate
  --> Perkinje of Cerebellum
  --> neocortex

3 causes of Lacunar Stroke

• all are due to chronic HTN --> by far most important
  --> secondary risk factors are diabetes and smoking
• lipohyalinosis (thickenning)
• microatheroma formation,
• hardening/thickening of the vessel wall
  --> = (hypertensive arteriolar sclerosis)

*MCA

• caontains the lenticulostriate artery
• Brain Blood supply: supplies upperlimbs and face of the HUMNCULUS
  --> upper limbs and face

* lenticulostriate artery

• most common artery affected by HTN and diabetes infarct CVAs
• hit the basal ganglia, usually putamen

*Putamen lenticulostriate CVA

• usually from Charcot-Bouchard aneurisms from chronic HTN, diabetes and smoking

*ACA

• caontains the Anterior communicating artery
• Brain Blood supply: supplies the middle sulcus of the HUMNCULUS
  --> lower limbs up to pelvis

*PONS

• lesions and bleeds present with PONS = PINPOINT PUPILS
• rapidly evolving coma
• loss of horizontal gaze
• quadraparesis

*Brainstem CVAs

Rule of 4s

• 4 CN rule = MIDNIGHT 12 MIDLINE CN
• 4 MEDIALs
  --> 2 MEDIAL GENERAL MOTOR (CorticoSPINE + corticoBULBAR CN)
  --> 2 MEDIAL specific (MEDIAL LF + MEDIAL Lemniscus)

4 MAINS = MEDIAL

Rule of 4

2 MEDIAL GENERAL MOTOR (CorticoSPINE + corticoBULBAR CN)

• MOTOR nuclei of CN cranial nerves
  --> all the groups from CN MIDNIGHT 12 = MIDLINE
  --> (above RULE of $ for CNs)
• MEDIAL /midline CORTICOspinal tract
  --> main muscle tracts
  --> everything below it will be affected
  
  

2 MEDIAL specific (MEDIAL LF + MEDIAL Lemniscus)

• MEDIAL lemniscus
  --> vibration and proprioception
• MLF = medial Longitudinal Fasciculus
  --> seen in MLF INO with MS SIN

*Brainstem CVAs

Rule of 4s

• 4 CN rule = MIDNIGHT 12 MIDLINE CN
• 4 MEDIALs
  --> 2 MEDIAL GENERAL MOTOR (CorticoSPINE + corticoBULBAR CN)
  --> 2 MEDIAL specific (MEDIAL LF + MEDIAL Lemniscus)