![]() ![]() With a stroke affecting the right (or nondominant) hemisphere, the patient may show signs of unilateral neglect. If your patient has left-sided weakness and aphasia, ask which is the dominant hand to better understand his or her signs and symptoms. A small percentage of left-handed persons have right-hemisphere dominance. Thus, expect a patient with right-sided weakness to have aphasia, and focus your exam accordingly. Most people are left-hemisphere dominant, meaning the speech/language center is in the brain’s left side. Does he or she simply nod or shake the head in response to a “yes” or “no” question? Be aware that patients with receptive aphasia can understand nonverbal communication, including the stress and intonation patterns of speech this may allow them to give the correct response. To quickly assess for receptive aphasia, ask the patient to follow commands for example, “Show me two fingers on your left hand” or “Open and close your eyes.” Note whether the patient follows these commands. Does he or she have difficulty naming objects or expressing thoughts? Throughout the exam, note how the patient converses with you. To quickly assess for expressive aphasia, ask the patient to name common objects, such as a pen, a watch, or a key. Aphasia may be expressive (difficulty converting thoughts into language), receptive (difficulty understanding verbal and written language), or both. If the stroke affects the left (or dominant) brain hemisphere, the patient may experience aphasia (partial or total loss of the ability to communicate through language). Laterality of an MCA stroke determines additional signs and symptoms. Also check for a palmar drift or hand or arm weakness. If your patient is uncooperative, observe spontaneous movement and look for differences between the right and left sides. If your patient can’t follow this or other commands, apply a noxious stimulus to induce a grimace, and observe for asymmetry of the lower part of the face. MCA strokes affect the face and arm more severely than the leg, so make sure to focus your assessment on the face and arm. contralateral homonymous hemianopia-visual-field deficits affecting the same half of the visual field in both eyes.contralateral (opposite-side) sensory loss in the same areas.hemiplegia (paralysis) of the contralateral side, affecting the lower part of the face, arm, and hand while largely sparing the leg.The hallmarks of an MCA stroke are the focus of most public-awareness messages and prehospital stroke assessment tools-facial asymmetry, arm weakness, and speech deficits. But an accident that blocks only a side street has a much smaller impact.) Effects of a complete MCA stroke (As an analogy, if a traffic accident occurs on a large interstate, the effect is severe, potentially disrupting an entire region or city. In contrast, occlusion of an MCA branch damages a smaller brain territory and causes less severe disability. Distribution of the MCA is so large that a stroke of the main stem puts the victim at risk for severe disability or death. Occlusion of the main stem affects the entire territory of brain supplied by the MCA. The MCA has a main stem and several branches arising from it. The MCA feeds an enormous territory of brain, including the frontal, temporal, and parietal lobes and the brain’s deep structures-basal ganglia and internal capsule. For this reason, signs and symptoms of MCA strokes are the most important to remember. The largest vessel branching off the internal carotid artery, the middle cerebral artery (MCA) is the most common cerebral occlusion site. More frequent assessment may be needed for a patient who is unstable, has fluctuating signs or symptoms, or has received thrombolytics. The American Stroke Association recommends clinicians perform neurologic assessments at least every 4 hours on patients with acute strokes. ![]() Then it describes how patientĪssessment differs by suspected stroke location. This article discusses the major cerebral blood vessels and the functional areas each vessel supplies-knowledge that helps you focus your neurologic assessment. Author Guidelines and Manuscript Submission.
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