Stroke

TACS: total anterior circulation syndrome

Relating to the same hemisphere, all of:

  • Contralateral hemiplegia: face, upper limb, lower limb
  • Contralateral hemianopia
  • Higher cortical dysfunction, e.g. dysphasia, visuospatial disorder/inattention/neglect

PACS: Partial anterior circulation syndrome

Relating to the same hemisphere, any of:

  • Motor/sensory deficit + hemianopia
  • Motor/sensory deficit + higher cortical dysfunction
  • Higher cerebral dysfunction + hemianopia
  • Pure motor/sensory deficit less extensive than for lacunar stroke, e.g. monoparesis
  • Higher cortical dysfunction alone

POCS: posterior circulation syndrome

Any of:

  • Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit
  • Bilateral motor and/or sensory deficit
  • Disordered conjugate eye movement
  • Cerebellar dysfunction without ipsilateral pyramidal defect (would suggest ataxic hemiparesis)
  • Isolated hemianopia or cortical blindness

Lacunar syndrome

  • Deficit of two of: face, UL, LL
  • Maximum deficit from a single vascular event
  • No visual field defect
  • No higher cortical dysfunction
  • No brainstem disturbance
  • No drowsiness

Stroke categories

  • Pure motor stroke. If face, UL & LL, usually in internal capsule or pons. If partial defect, usually corona radiata.
  • Pure sensory stroke. Usually thalamus.
  • Sensorimotor stroke. Corona radiata, internal capsule, thalamus.

Bell's palsy

History

  • Postauricular pain in about 50%, may precede facial weakness
  • Increased tear flow - not due to increased production, but reduced transport to lacrimal sac by orbicularis oculi
  • Altered taste reported by a third, though 80% show reduced taste on examination (only half of tongue involved)
  • Dry eyes
  • Hyperacusis - impaired tolerance to loud noise due to sensory irritation

Findings

  • Weakness of entire face. Focus on upper face: orbicularis, frontalis and corrugator muscles
  • Other cranial nerves should be normal
  • Tympanic membranes should not be inflamed: suggests otitis media

Treatment

  • Prednisolone 25mg bd for 10 days
  • No proven benefit of aciclovir