B7.062 Stroke Syndromes Flashcards
symptoms of left internal carotid occlusion
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
abulia
absence of willpower
neglect
patient does not pay attention to half of their body
due to damage in non-dominant hemisphere
course of ophthalmic artery
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)
what does the ophthalmic artery perfuse
optic nerve and retina
what is recurrent transient monocular blindness
occurs with infarction of ophthalmic artery
manifests in 25% of patients with symptomatic internal carotid disease
transient ischemic attack
what does the MCA supply
most of the temporal lobe
anterolateral frontal lobe
parietal lobe
what do the perforating branches of the MCA supply
posterior limb of the internal capsule
part of the head and body of the caudate
globus pallidus
L MCA stem occlusion symptoms (proximal to penetrators)
contralateral hemiplegia affecting face, arm, leg
contralateral homonymous hemianopia
ipsilateral head/eye deviation
global aphasia, alexia, agraphia, acalculia, apraxia
R MCA stem occlusion symptoms (proximal to penetrators)
contralateral hemiplegia affecting face, arm, leg
contralateral homonymous hemianopia
ipsilateral head/eye deviation
neglect, agnosia, apraxia, aprosody
prosody
expressivity in voice
aprosody = lesion on non-dominant hemisphere
lenticulostriate arteries
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
lenticulostriate lesion symptoms
damage to internal capsule: contralateral hemiparesis and sensory deficit
what is a lacunar syndrome
occlusion of deep branches of the MCA or basilar artery
preservation of cortical function (language, cognitive, visual)
location and appearance of lacunar infarcts
80% : periventricular white matter and basal ganglia
20%: cerebellum and brain stem
0.5-1.5 cm in diameter
symptoms of inferior MCA division infarct
superior quadrantanopia / homonymous hemianopia
Wernicke aphasia (deficit in comprehension if dominant hemisphere)
Left sides neglect ( if non dominant hemisphere)
cortical sensory loss
symptoms of superior MCA division infarct
brachiofacial paralysis sensorimotor deficit involving face and arm, leg to a lesser extent foot is spared ipsilateral deviation of head/eyes non-fluent aphasia
course of ACA
supplies most of the medial surface of the cerebral cortex (anterior 3/4), frontal pole, and anterior portions of the corpus callosum
unilateral ACA occlusion
contralateral sensorimotor deficits mainly involving the lower extremity with sparing of face and hands
bilateral ACA occlusion
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)
what are the PCAs
terminal branches of the basilar artery
PCA course
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
2 syndromes associated with PCA occlusion
P1: midbrain, subthalamic, and thalamic signs
P2: cortical temporal and occipital lobe signs
symptoms of basilar artery occlusion
bilateral long tract symptoms
bilateral CN abnormalities
coma
artery that supplies the lateral medulla
PICA
