1 - Vascular Syndromes and Lesions Flashcards
What is the major blood supply for internal structures?
What is unique about paramedian penetrating arteries?
What supplies lateral structures?
Penetrating Arteries
They “respect the midline”, do not cross over
Short / Long circumferential arteries
Midbrain Vascular Supply
Posterior Cerebral Artery (PCA)
top of Basilar Artery (paramedian branches)
Superior Cerebellar Artery (SCA) - tectum
Pons Vascular Supply
Basilar Artery (Paramedian, Circumferential)
Anterior Inferior Cerebellar Artery (AICA) - Caudal Pons
Superior Cerebellar Artery (SCA) - Dorsal, Rostral Pons
Rostral Pons Vascular Supply
Basilar Artery (paramedian branches, circumferential branches)
Superior Cerebellar Artery (SCA) - Dorsal, Rostral pons
Caudal Pons Vascular Supply
Basilar Artery (Paramedian, Circumferential)
Anterior Inferior Cerebellar Artery (AICA) - Caudal Pons
Medulla Vascular Supply
Anterior Spinal Artery
Vertebral Artery (paramedian branches)
Posterior Inferior Cerebellar Artery (PICA) - lateral
General features of vertebrobasilar vascular disease?
Crossed Signs (decreased sensation on one side of face, contralateral body)
Cranial Nerve abnormalities
Diplopia, Dysconjugate Gaze
Vertigo, Nausea
Ataxia
Dysarthria (speech), Dysphagia (swalling)
Reduced Consciouness
Altered Breathing
Clinical: Vascular Syndromes of Medulla
Lateral Medullary Syndrome (Wallenberg’s Syndrome)
Blood: PICA Syndrome - can also involve vertebral artery
Symptoms / Pathway:
1. Ipsilateral Ataxia, Vertigo/nystagmus/nausea / inferior cerebellar peduncle, vestibular nuclei
2. Decreased pain , temperature sensation for ipsilateral face / spinal trigmeinal nucleus and tract; and contralateral body - anterolateral system
3. Ipsilateral Horner’s Syndrome / descending sympathetic fibers
4. Hoarseness/Dysphagia / nucleus ambiguus
5. Ipsilateral Decreased Taste / solitary nucleus
Clinical: Vascular Syndromes of Medulla
Medial Medullary Syndrome
Blood: Anterior Spinal Artery, Paramedian Branches of Vertebral Artery
Symptom / Pathway:
1. Contralateral Arm, Leg weakness / corticospinal tract
2. Contralateral loss of fine touch, vibration, conscious proprioception / Medial lemniscus
3. Ipsilateral tongue weakness / Hypoglossal nucleus/nerve
Clinical: Vascular Syndromes of Pons
Dysarthria Hemiparesis (Pure Motor Hemiparesis)
Blood: Paramedian Branches of basilar artery
Symptom / Pathway: Contralateral lower face, arm, leg weakness, dysarthria / corticospinal, corticobulbar
Clinical: Vascular Syndromes of Pons
Ataxic Hemiparesis
Blood: Paramedian branches of basilar artery
Symptom/Pathway:
1. Contralateral lower face, arm, leg, dysartheria / corticospinal, corticobulbar
2. ***Ataxia / pontine nuclei, pontocerebellar fibers***
Clinical: Vascular Sundromes of Pons
Medial Pontine Basis / Tegmentum
Blood Supply: Paramedian branches of basilar artery
Symptoms / Tract:
- Contralateral lower face, arm, leg weakness, dysartheria / Corticospinal, Corticobulbar
- Ipsilateral Face Weakness / Facial Colliculus
- Ipsilateral Horizontal Gaze Palsy / Abducens Nucleus, PPRF
- Intranuclear Ophthalmoplegia / MLF
- Contralateral loss of fine touch, vivration, conscious proprioception / Medial Lemniscus
Clinical: Vascular Syndromes of Pons
AICA Syndrome (Lateral Caudal Pons)
Blood Vessel: AICA
Symptoms / Pathway:
- Ipsilateral Ataxia / Middle Cerebellar Peduncle
- Vertigo, Nystagmus / Vestibular Nuclei
- Decreased Pain, Temperature Sensation for Ipsilateral Face / Spinal Trigeminal Nucleus and Tract
- Ipsilateral Horner’s Syndrome / Descending Sympathetic Fibers
- Ipsilateral Hearing Loss / Labryinthine Artery (inner ear)
Clinical: Vascular Syndromes of Midbrain
Midbrain Basis (Weber’s Syndrome)
Blood Supply: Branches of PCA, top of basilar artery
Symptoms / Pathway:
- Ipsilateral Third Nerve Palsy / Oculomotor Nerve Fascicles
- Contralateral Hemiparesis / Cerebral Peduncle
Clincial: Vascular Syndromes of Midbrain
Midbrain Tegmentum (Claude’s Sundrome)
Blood: Branches of PCA, top of basilar artery
Symptoms / Pathways:
- Ipsilateral Third nerve palsy / Oculomotor Nerve Fascicles
- Contralateral Ataxia / Red Nucleus, Fibers of Superior Cerebellar Peduncles
Clinical: Vascular Syndromes of Midbrain
Midnrain Basis + Tegmentum (Benedickt’s Syndrome = Claude + Weber)
Blood: Branches of PCA, top of Basilar Artery
Symptom / Tract:
- Ipsilateral Third Nerve Palsy / Oculomotor Nerve Fasicles
- Contralateral Hemiparesis / Cerebral Peduncle
- Contralateral Ataxia / Red Nucleus, Fibers of Superior Cerebellar peduncles
Clinical: Top-of-the-Basilar Syndrome
Blood: Branches of PCA, Top of Basilar Artery
Symptoms / Pathway:
- Vision, Memory disturbance / PCA supplies occipital, temporal lobe
- Eye movement disorder / Oculomotor Nuclei, Nerve Fasciles
- Altered Consciousness / Midbrain reticular formation
- Ataxia / entire Cerebellum
Clinical: Pontine Hemorrhage
Blood: Paramedian branches of basilar artery and junction of tegmentime and base
Can have a wide variety of effexts
Clinical: Locked-in Syndrome
Area Affected: Vilateral ventral pons (bilateral corticobulbar / corticospinal tracts)
No impairment to consciousness, but unable to move
Vertical eye movement, Sensory pathway usually spared,
Clinical: Dorsal Midbrain (Parinaud’s) Syndrome
Causes: Stroke, Compression of dorsal midrain, pretectal area (pineal tumor, hydrocephalus)
Symptoms / Pathways:
- Impairment of Vertical Gaze (upward) / Vertical Gaze Center
2, Large, Irregular blown pupils / Damage to Edinger-Westphal nucleus
- Eyelid Abnormalities (retraction, ptosis) / Oculomotor Nuclei
- Impaired Convergence / Vergence control center
