14. Clinical syndromes of impaired circulation of the internal carotid artery

Question 1

Branches of ICA

Answer 1

1. Anterior cerebral artery
2. Middle cerebral artery
3. Posterior communicating artery

Question 2

Neurological signs of extreme impaired circulation of ICA

Answer 2

• Detoriation, unconciousness
• Homonymous hemianopsia (visual field loss on the same side of both eyes)
• Contralateral hemiplegia
• Contralateral hemisensory disturbance
• Gaze palsy to opposite side (eyes deviate to side of lesion)

Question 3

Etiology of impaired circulation of ICA

Answer 3

Progressing narrowing of lumen (atherosclerosis) or recurrent emboli

Question 4

Anterior cerebral artery supplies

Answer 4

Medial surface of the hemisphere (orbital, frontal, parietal) + basal ganglia

Question 5

Occlusion of anterior cerebral artery sympt.

Answer 5

• Proximal occlusion: well-tolerated(due to flow of anterior communicating artery)
• Distal occlusion: weakness + sensory loss of contralateral lower limb (primary somatosensory and motor cortex)

Question 6

Middle cerebral artery supplies

Answer 6

Frontal, parietal, temporal+ basal ganglia

Question 7

Clinical picture of occlusion of middle cerebral artery

Answer 7

Clinical if all cortical branches are involved (occlusion at insula)
- Contralateral hemiplegia*
- Contralateral hemianesthesia
- Contralateraal hemianopia
- Aphasia
- Neglet of contralateral limbs

Primary somatosensory cortex, primary motor cortex, frontal eye field, Brocas and wernicke area

Question 8

Carotid artery stenosis

Answer 8

• Atherosclerotic disease of ICA
• Amaurosis fugax = transient monocular/binocular loss of vision
• TIA
• Stroke
• Diagnosis: US
• Treatment: life-style changes, anti-platelets, statins, anti-hypertensive
• Carotid revascularization (stenting) if severe!

Question 9

Function of frontal lobe

Answer 9

• Primary motor cortex: voluntary movement
• Broca’s area: expressive language
• Pre-frontal cortex memory, emotions, problem solving

Question 10

Parietal lobe

Answer 10

• Primary somatosensory cortex: conscious awareness of somatic sensation
• Somatosensory association cortex: analyze, recognize, and memorize somatic sensation

sensory perception and integration, including the management of taste, hearing, sight, touch, and smell

Question 11

Temporal lobe

Answer 11

Processing auditory information and with the encoding of memory. Contains Wernicke.

• Primary auditory cortex
• Wernickes area
• Primary olfactory cortex
• Insular cortex

Question 12

Clinical features of MCA occlusion:

Answer 12

• Contralateral weakness and sensory loss marked in the upper limbs and lower half of the face
• Gaze deviates toward the side of infarction
• Contralateral homonymous hemianopia
• Aphasia if in dominant hemisphere (usually left MCA territory): Broca, wernicke or conduction aphasia
• Hemineglect if in nondominant hemisphere (usually right MCA territory): unawareness of and unresponsiveness to unilateral stimuli. Lesion usually contralateral to the stimuli