Blood supply to the brain

Question 1

Proximal upper and lower extremity weakness, “man in barrel syndrome”

higher order visual dysfunction

Answer 1

Infarct d/t hypotension to watershed areas

-visual dysfunction if posterior cerebral/middle cerebral cortex border zone stroke

Question 2

Dural venous sinuses drain into

Answer 2

internal jugular vein

between periosteal and meningeal layers of dura mater
drain blood from cerebral veins and receive CSF from arachnoid granulations

Question 3

12-24 hr since ischemic stroke histo

Answer 3

eosinophilic cytoplasm
pyknotic nuclei (red neurons)

Question 4

24-72 hr since ischemic stroke histo

Answer 4

necrosis

neutrophils

Question 5

3-5 days since ischemic stroke histo

Answer 5

macrophages (microglia)

Question 6

1-2 weeks since ischemic stroke histo

Answer 6

reactive gliosis (astrocytes)
vascular proliferation

Question 7

> 2 weeks since ischemic stroke histo

Answer 7

glial scar

Question 8

Pure motor stroke
contralateral paralysis
no cortical signs (neglect, aphasia, visual field loss)

Answer 8

lenticulostriate artery

• striatum
• internal capsule

lacunar infarcts d/t hyaline arteriosclerosis (lipohyalinosis) secondary to unmanaged HTN

Question 9

contralateral paralysis UE and LE
decreased contralateral proprioception
ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)

Answer 9

anterior spinal artery “medial medullary syndrome”

• lateral corticospinal tract
• medial lemniscus
• caudal medulla - hypoglossal nerve

Question 10

dysphagia
hoarseness
decreased gag reflex, hiccups
vomiting, vertigo, nystagmus
decreased contralateral body pain/temp, ipsilateral face
ipsilateral Horner syndrome
ipsilateral ataxia, dysmetria

Answer 10

posterior inferior cerebellar artery “lateral medullary syndrome” (Wallenberg)

• lateral medulla (nucleus ambiguus CN IX, X, XI)
• vestibular nuclei = lateral spinothalamic tract, spinal trigeminal nucleus
• sympathetic fibers
• inferior cerebellar peduncle

Question 11

Sx’s specific for PICA lesions

Answer 11

nucleus ambiguus

• CN IX, X, XI
• dysphagia, hoarseness, decreased gag reflex

Question 12

• Paralysis of whole half of face
• decreased lacrimation, salivation, taste from anterior 2/3 tongue
• vomiting, vertigo, nystagmus
• decreased contralateral body pain/temp, ipsilateral face
• ipsilateral Horner
• ipsilateral ataxia, dysmetria
• ipsilateral sensorineural deafness

Answer 12

anterior inferior cerebellar artery “lateral pontine syndrome”

• lateral pons (facial nucleus)
• vestibular nuclei = lateral spinothalamic tract, spinal trigeminal nucleus
• sympathetic fibers
• middle/inferior cerebellar peduncles
• labyrinthine artery

Question 13

Facial droop and facial nucleus are specific for

Answer 13

AICA lesion

Question 14

Locked-in syndrome

Answer 14

Basilar artery

Question 15

• Quadriplegia
• loss of voluntary facial, mouth, tongue movements
• loss of horizontal, but not vertical eye movements
• preserved consciousness

Answer 15

Basilar artery

• pons, medulla, lower midbrain
• corticospinal and corticobulbar tracts
• ocular cranial nerve nuclei, paramedian pontine reticular formation

Question 16

contralateral hemianopia w/macula sparing

alexia without agraphia (dominant hemisphere)

Answer 16

posterior cerebral artery

-occipital lobe

Question 17

Saccular aneurysm compressing PCom Sx’s

Answer 17

ipsilateral CN III palsy
mydriasis
“blown, down and out pupil”