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

Question 1

how impaired circulation of the internal carotid artery may present?

Answer 1

May present in a stuttering manner due to progressing narrowing of the lumen or recurrent emboli

Question 2

Signs and symptoms of impaired circulation of the internal carotid artery?

Answer 2

most extreme cases there may be:
○ Deterioration of consciousness
○ Homonymous hemianopia of the contralat side
○ Contralat hemiplegia
○ Contralat hemisensory disturbance
○ Gaze palsy to opposite side, eyes deviated to the side of lesion

●A partial Horner’s sy. may develop (SY fibers on the ICA wall)
● Occlusion of the dominant hemisphere → global aphasia

Question 3

Examination of impaired circulation of the internal carotid artery?

Answer 3

● Absent carotid pulsation at the jaw angle w/ poorly conducted heart sounds along ICA
● Prodromal symptoms prior to occlusion, like temporary monocular blindness and transient hemisensory/hemimotor disturbance
● The outcome of carotid occlusion depends on the collateral blood supply primarily from circle of
Willis and also ECA

Question 4

where does Ant. Cerebral Art. comes from and what is its course and what it supplies?

Answer 4

● Branch from ICA running above optic n. to follow the curve of corpus
callosum, joined by ant. communicating artery close to the
origin and it gives deep branches into
internal capsule and basal nuclei

● Cortical branches supply the medial
surface of the hemisphere (orbital,
frontal, parietal)

Question 5

what does the Clinical features of Ant. cerebral Art. depends on?

Answer 5

• site of occlusion (in relation to ant. communicating art.) and
• anatomical
  variation

Question 6

what are the Clinical features of Proximal occlusion of Ant. cerebral Art.?

Answer 6

normally well tolerated because of the cross flow through ant. communicating art.

Question 7

what are the Clinical features of Distal occlusion of Ant. cerebral Art.?

Answer 7

weakness and cortical
sensory loss in contralat lower limb w/ associated incontinence

occasionally contralat
grasp reflex

Question 8

what are the Clinical features of Proximal occlusion when both ant. cerebral aa arise from the same side of Ant. cerebral Art.?

Answer 8

cerebral paraplegia w/ lower limb weakness, sensory loss, incontinence and grasp, snout and palmomental reflexes

Question 9

what are the Clinical features of Bilateral frontal lobe infarction related to Ant. cerebral Art.?

Answer 9

akinetic mutism, deterioration in conscious level

Question 10

where does Middle cerebral artery comes from and what is its course and what it supplies?

Answer 10

The largest branch of ICA passing to the lateral surface of the hemisphere and giving off:

1) Deep branches (perforating vessels) supplying ant. limb of internal capsule and part of basal nuclei
2) Cortical branches
3) Temporal
4) Frontal
5) Parietal

Question 11

what does the Clinical features of Middle cerebral artery depends on?

Answer 11

• site of occlusion
• whether the dominant/non-dominant hemisphere is affected

Question 12

if occlusion of the middle cerebral artery occurs at the insula which branches are involved?
what are the symptoms?

Answer 12

all cortical branches are involved

■ Contralat hemiplegia
■ Contralat hemianesthesia and hemianopia
■ Aphasia (dominant)
■ Neglect of contralat limbs and dressing difficulty (non-dominant)

Question 13

what happens if cortical branches of MCA are affected individually?

Answer 13

clinical picture is less severe

Question 14

what happens if deep branches of MCA are affected?

Answer 14

hemorrhage and small infarcts