Blood Supply Injuries

Question 1

what is quadriplegia/paresis?

Answer 1

all 4 extremities are paralyzed or weak

Question 2

what is hemiplegia/paresis?

Answer 2

upper and lower extremities on 1 side are paralyzed or weak (1/2 body affected)

Question 3

what is paraplegia/paresis?

Answer 3

both upper OR lower extremities are paralyzed or weak

Question 4

what is monoplegia/paresis?

Answer 4

one extremity is paralyzed or weak

Question 5

what is an internal carotid infarction?

Answer 5

the internal carotid arteries may become atherosclerotic and eventually occluded

Question 6

the extent of an internal carotid infarction may include the territories of the…

Answer 6

anterior and middle cerebral arteries

Question 7

the ophthalmic artery is one of the first branches of the ____

Answer 7

internal carotid artery

Question 8

occlusion of the ophthalmic artery causes…

Answer 8

unilateral visual symptoms such as dimming, colour changes, or scotomas

Question 9

anterior cerebral infarction causes symptoms of injury to the…

Answer 9

medial cerebral hemisphere

Question 10

symptoms of anterior cerebral infarction

Answer 10

• contra spastic paralysis & sensory loss of mainly distal leg & perinium (incontinence) [paracentral lobule]
• mental confusion, impaired judgement, flat affect [prefrontal lobe]
• abulia [bilateral prefrontal lobe]

Question 11

what is abulia?

Answer 11

behavioural disturbance characterized by apathy & muteness

Question 12

anterior choroidal infarction causes symptoms of injury to the…

Answer 12

posterior limb of internal capsule and optic tract/LGB

Question 13

symptoms of anterior choroidal infarction

Answer 13

• contra spastic paralysis & sensory loss of body & face [internal capsule]
• contra homonymous hemianopsia [LGB]

Question 14

middle cerebral infarction causes symptoms of injury to the…

Answer 14

lateral cerebral cortex

Question 15

symptoms of middle cerebral infarction

Answer 15

• contra spastic paralysis & sensory loss of face & upper extremity [precentral & postcentral gyrus]
• contra homonymous hemianopsia [optic radiation]
• acute (1-2days) paresis of contra conjugate gaze [frontal eye field]
• aphasia [Broca’s, Wernicke’s, global] if dominant side affected
• astereognosis/neglect [right parietal lobe]
• apraxia [premotor cortex]
• Gerstmann’s syndrome

Question 16

injury to left angular gyrus causes symptoms of ____

Answer 16

Gerstmann’s syndrome

Question 17

what is Gerstmann’s syndrome?

Answer 17

• agraphia
• acalculia
• inability to distinguish L from R
• finger agnosia

Question 18

symptoms of distal occlusion of posterior cerebral artery affecting the striate cortex

Answer 18

contra homonymous hemianopsia

Question 19

symptoms of distal occlusion of posterior cerebral artery affecting splenium

Answer 19

alexia (unable to read) without agraphia (unable to write)

Question 20

symptoms of proximal bilateral occlusion of posterior cerebral artery affecting basilar junction including both visual cortices

Answer 20

Anton’s syndrome (failure of blind patient to recognize inability to see)

Question 21

symptoms of proximal occlusion of posterior cerebral artery

Answer 21

• contra sensory loss or thalamic syndrome [thalamus]
• hemiballism [subthalamic nucleus]
• midbrain symptoms

Question 22

what is the prognosis of a substantial hemorrhage within the brainstem?

Answer 22

• instantly fatal (medulla & pons reticular formation) OR
• coma due to failure of central control of respiration

Question 23

what is locked in syndrome?

Answer 23

large infarction of ventral pons (basilar a) causing paralysis of all voluntary movements except movements of the eyes

Question 24

what are the overlapping symptoms of a medial stroke of the medulla and pons?

Answer 24

1. contra spastic paralysis (corticospinal in basilar pons/pyramid)
2. contra loss of vibration, proprio, etc (ML)

Question 25

what arteries supply the medial medulla and pons?

Answer 25

anterior spinal (medulla) short pontine (pons)

Question 26

what are the symptoms of a medial stroke of the **pons** only?

Answer 26

1. medial strabismus (CN VI)/paralysis of horizontal gaze to side of lesion (inf pons) 2. internuclear ophthalmoplegia (MLF)

Question 27

what are the symptoms of a medial stroke of the **medulla** only?

Answer 27

ipsilateral tongue paralysis (CN XII)

Question 28

what arteries supply the lateral medulla and pons?

Answer 28

Posterior inferior cerebellar a (medulla) Anterior inferior cerebellar a/superior cerebellar (pons)

Question 29

what are the overlapping symptoms of a lateral stroke of the pons & medulla?

Answer 29

1. contra loss of P&T from body (spinothalamic) 2. ipsi loss of P&T from face (nucleus of SToV; medulla), touch from face (chief sensory; pons) 3. nystagmus (vestibular nuc) 4. cerebellar symptoms 5. ipsi Horner's (reticular formation) 6. Hiccup (reticular formation)

Question 30

what are the symptoms of a lateral stroke of the **medulla** only?

Answer 30

Wallenberg syndrome: 1. dysphagia, hoarseness, uvular deviation or absence of gag reflex (nuc ambiguus, CN X) 2. loss of taste (solitary tract/nuc)

Question 31

what artery supplies the lateral medulla?

Answer 31

- posterior inferior cerebellar a - vertebral a

Question 32

what are the symptoms of a lateral stroke of the **lower pons** only?

Answer 32

1. ipsilateral facial paralysis (bell's palsy, CN VII) 2. deafness (cochlear nuclei)

Question 33

what artery supplies the lateral lower pons?

Answer 33

anterior inferior cerebellar a

Question 34

what are the symptoms of a lateral stroke of the **midpons** only?

Answer 34

inability to chew & jaw deviation (CN V)

Question 35

name 3 syndromes caused by posterior cerebral strokes

Answer 35

- dorsal midbrain syndrome (Perinaud's/pinealoma) - ventral midbrain syndrome (weber's) - central midbrain syndrome (claude's)

Question 36

symptoms of dorsal midbrain syndrome

Answer 36

- paralysis of upward gaze - loss of pupillary/light reflex (pretectal nuc)

Question 37

symptoms of ventral midbrain syndrome

Answer 37

- contra paralysis of body & face (crus cerebri: CST) - ipsi oculomotor palsy (ptosis, mydriasis, lateral strabismus)

Question 38

symptoms of central midbrain syndrome

Answer 38

- ipsi oculomotor palsy - hemiballism (subthalamic nuc) - contra loss of sensation (P&T, vibration, position)

Question 39

combination of ventral & central midbrain syndromes is called ____

Answer 39

Benedikt syndrome