Anatomy of Stroke

Question 1

Anterior cerebral artery lesion associated effects?

Answer 1

Contralateral (opposite body side) hemiparesis/weakness and sensory loss, lower extremity > upper

So anterior = weakness on legs of opposite side.

Question 2

Middle cerebral artery lesion associated effects?

Answer 2

Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia (inability to comprehend or produce coherent language)

So middle = weakness on arms on opposite side along with opposite side homonymous hemianopia.

Question 3

Posterior cerebral artery lesion associated affects?

Answer 3

Contralateral homonymous hemianopia with macular sparing

Visual agnosia (can see but can’t interpret visual information - affect parietal lobes)

Question 4

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain) lesion and associated effects?

Answer 4

Ipsilateral CN III palsy
Contralateral
weakness of upper and lower extremity

Question 5

Posterior inferior cerebellar artery (lateral medullary syndrome,
Wallenberg syndrome) lesion and associated symptoms?

Answer 5

Ipsilateral (same side): facial pain and temperature loss

Contralateral (opposite side) :
limb/torso pain and temperature loss
Ataxia, nystagmus

Question 6

Anterior inferior cerebellar artery (lateral pontine syndrome) lesion and associated symptoms?

Answer 6

Ipsilateral: facial paralysis and deafness

Overall symptoms are similar to posterior inferior cerebellar artery lesion.

Question 7

Retinal/ophthalmic artery lesion and associated symptoms?

Answer 7

Amaurosis fugax (painless temporary loss of vision in one or both eyes)

Question 8

Basilar artery lesion and associated symptoms?

Answer 8

‘Locked-in’ syndrome

Question 9

What is “locked in” syndrome?

Answer 9

a rare disorder of the nervous system

Results in paralysis except for the muscles that control eye movement.

Patients are conscious (aware) and can think and reason, but cannot move or speak; although they may be able to communicate with blinking eye movements.

Question 10

How does lacunar stroke present?

Answer 10

present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

strong association with hypertension

common sites include the basal ganglia, thalamus and internal capsule

Question 11

Main arteries supplying the brain?

Answer 11

Internal carotid arteries and vertebral arteries

The internal carotid arteries branch to form two major cerebral arteries, the anterior and middle cerebral arteries.

The right and left vertebral arteries come together at the level of the pons on the ventral surface of the brainstem to form the midline basilar artery.

Question 12

Difference between homonymous hemianopia in MCA vs PCA?

Answer 12

In MCA, homonymous hemianopia is contralateral whereas in PCA homonymous hemianopia is contralateral with macular sparing.

Macular sparing = visual field loss that preserves vision in the center of the visual field, otherwise known as the macula.