B7.062 Stroke Syndromes

Question 1

symptoms of left internal carotid occlusion

Answer 1

similar to MCA but with additional ophthalmic involvement
abulia
contralateral homonymous hemianopia
contralateral hemiplegia
contralateral hemisensory disturbance
gaze preference to side of lesion
aphasia if dominant
neglect if non dominant

Question 2

abulia

Answer 2

absence of willpower

Question 3

neglect

Answer 3

patient does not pay attention to half of their body

due to damage in non-dominant hemisphere

Question 4

course of ophthalmic artery

Answer 4

branches from ICA, below anterior clinoid process
supplies globe, orbit, frontal scalp, and fontal and ethmoidal sinuses
branches anastomose with maxillary artery branches (potential for collateral flow)

Question 5

what does the ophthalmic artery perfuse

Answer 5

optic nerve and retina

Question 6

what is recurrent transient monocular blindness

Answer 6

occurs with infarction of ophthalmic artery
manifests in 25% of patients with symptomatic internal carotid disease
transient ischemic attack

Question 7

what does the MCA supply

Answer 7

most of the temporal lobe
anterolateral frontal lobe
parietal lobe

Question 8

what do the perforating branches of the MCA supply

Answer 8

posterior limb of the internal capsule
part of the head and body of the caudate
globus pallidus

Question 9

L MCA stem occlusion symptoms (proximal to penetrators)

Answer 9

contralateral hemiplegia affecting face, arm, leg
contralateral homonymous hemianopia
ipsilateral head/eye deviation
global aphasia, alexia, agraphia, acalculia, apraxia

Question 10

R MCA stem occlusion symptoms (proximal to penetrators)

Answer 10

contralateral hemiplegia affecting face, arm, leg
contralateral homonymous hemianopia
ipsilateral head/eye deviation
neglect, agnosia, apraxia, aprosody

Question 11

prosody

Answer 11

expressivity in voice

aprosody = lesion on non-dominant hemisphere

Question 12

lenticulostriate arteries

Answer 12

branch of M1 segment of MCA
supplies basal ganglia structures: part of head and body of caudate, globus pallidus, putamen, and the posterior limb of the internal capsule

Question 13

lenticulostriate lesion symptoms

Answer 13

damage to internal capsule: contralateral hemiparesis and sensory deficit

Question 14

what is a lacunar syndrome

Answer 14

occlusion of deep branches of the MCA or basilar artery

preservation of cortical function (language, cognitive, visual)

Question 15

location and appearance of lacunar infarcts

Answer 15

80% : periventricular white matter and basal ganglia
20%: cerebellum and brain stem
0.5-1.5 cm in diameter

Question 16

symptoms of inferior MCA division infarct

Answer 16

superior quadrantanopia / homonymous hemianopia
Wernicke aphasia (deficit in comprehension if dominant hemisphere)
Left sides neglect ( if non dominant hemisphere)
cortical sensory loss

Question 17

symptoms of superior MCA division infarct

Answer 17

brachiofacial paralysis
sensorimotor deficit involving face and arm, leg to a lesser extent
foot is spared
ipsilateral deviation of head/eyes
non-fluent aphasia

Question 18

course of ACA

Answer 18

supplies most of the medial surface of the cerebral cortex (anterior 3/4), frontal pole, and anterior portions of the corpus callosum

Question 19

unilateral ACA occlusion

Answer 19

contralateral sensorimotor deficits mainly involving the lower extremity with sparing of face and hands

Question 20

bilateral ACA occlusion

Answer 20

infarction of the anteromedial surface of the cerebral hemispheres

• paraplegia affecting LEs and sparing face/hands
• incontinence
• abulic and motor aphasia
• frontal lobe symptoms (personality chance, contralateral grasp reflex)

Question 21

what are the PCAs

Answer 21

terminal branches of the basilar artery

Question 22

PCA course

Answer 22

small perforating branches supply midbrain structures, choroid plexus, and posterior thalamus
cortical branches supply the undersurface of the temporal lobe and occipital and visual cortex

Question 23

2 syndromes associated with PCA occlusion

Answer 23

P1: midbrain, subthalamic, and thalamic signs
P2: cortical temporal and occipital lobe signs

Question 24

symptoms of basilar artery occlusion

Answer 24

bilateral long tract symptoms
bilateral CN abnormalities
coma

Question 25

artery that supplies the lateral medulla

Answer 25

PICA