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Neuro Exam 2 > Brainstem Strokes > Flashcards

Brainstem Strokes Flashcards

1
Q

cortical findings of stroke

A

*language abnormalities
*gaze preferences
*neglect syndromes
*cortical sensory findings
*personality changes
*hemibody symptoms

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2
Q

4 types of herniation

A
  1. subfalcine herniation
  2. transtentorial central herniation
  3. transtentorial uncal herniation
  4. cerebellar (tonsillar) herniation
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3
Q

subfalcine (cingulate) herniation

A

*lateral displacement of the cingulate gyrus beneath the falx cerebri
*can cause compression of ACA, leading to ischemia/stroke
*causes a midline shift!
*main symptom = drowsiness

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4
Q

transtentorial central herniation

A

*caudal (downward) displacement of the temporal lobe and brainstem
*can cause rupture of basilar artery branches, leading to hemorrhages in midbrain and upper pons

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5
Q

transtentorial uncal herniation

A

*occurs when the uncus (medial temporal lobe) is squeezed downward past the tentorium cerebelli
*can compresses CN III and cause oculomotor palsy and/or ipsilateral hemiparesis

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6
Q

cerebellar (tonsillar) herniation

A

*herniation of the cerebellar tonsils through the foramen magnum
*can result in compression of the lower brainstem, leading to dysregulation of cardiac and respiratory centers, coma, and death

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7
Q

left (dominant) MCA syndrome

A

*aphasia
*right homonymous hemianopsia
*right hemiparesis (arm > leg)
*right hemisensory loss
*left gaze preference

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8
Q

right (nondominant) MCA syndrome

A

*left neglect (hemiattention)
*left homonymous hemianopsia
*left hemiparesis (arm > leg)
*left hemisensory loss
*right gaze preference

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9
Q

ACA syndrome

A

*very uncommon
*hemiparesis (leg > arm/face)
*gaze preference
*sensory loss (leg > arm/face)
*behavioral disorders
*incontinence

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10
Q

PCA syndrome

A

*hemianopia or cortical blindness if bilateral
*visual behavioral disorders (palinopsia, prosopagnosia, alexia, color anomia)
*temporal lobe involvement may cause aphasia and memory loss
*thalamic involvement can cause sensory loss

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11
Q

cerebellum - overview

A

*coordination center of the brain
*responsible for motor timing
*all output from the cerebellum is inhibitory
*main motor output: dentate -> cerebellar peduncle -> contralateral red nucleus -> thalamus - motor cortex

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12
Q

symptoms of cerebellar dysfunction

A

*dizziness
*ipsilateral ataxia
*nausea/vomiting
*double vision
*difficulty with balance

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13
Q

small-vessel (lacunar) syndromes

A

*small, deep infarcts in the distribution of the lenticulostriates, thalamoperforators, or paramedian branches of the basilar
*25% of strokes
*pathology is fibrinoid necrosis, lipohyalinosis, and microatheroma
*risk factors = HTN, DM, tobacco abuse, hyperlipidemia
*NO CORTICAL FINDINGS ON EXAM

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14
Q

5 classic lacunar syndromes

A
  1. pure motor hemiparesis (internal capsule or ventral pons)
  2. pure sensory stroke (thalamic stroke/lesion)
  3. clumsy-hand, dysarthria syndrome (pons or internal capsule)
  4. sensorimotor stroke (often thalamus + internal capsule)
  5. ataxic hemiparesis (frontal lobe in white matter)
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15
Q

brainstem lesions

A

*clinical hallmark = CROSSED FINDINGS (one symptom on one side of the body and different signs on the other side)

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16
Q

blood supply of lateral midbrain

A

*PCA (and some SCA)

17
Q

blood supply of medial midbrain

A

PCA / basilar

18
Q

blood supply of lateral pons

A

AICA

19
Q

blood supply of medial pons

A

basilar

20
Q

blood supply of lateral medulla

A

PICA

21
Q

blood supply of medial medulla

A

anterior spinal artery (ASA)

22
Q

medial medullary syndrome

A

*anterior spinal artery stroke
*contralateral weakness
*contralateral loss of vibration and proprioception
*ipsilateral tongue deviation
*NO loss of pain/temp

23
Q

lesion in frontal eye fields (FEF)

A

*ipsilateral gaze preference (eyes to side of lesion)
*cortical problem

24
Q

lesion in paramedian pontine reticular formation (PPRF)

A

*brainstem gaze palsy (both eyes won’t move past midline at all TOWARDS the side of the lesion)

25
Q

lesion in medial longitudinal fasciculus (MLF)

A

*internuclear ophthalmoplegia
(lesion in R MLF = right INO: right eye will not look medially when left eye is abducted, causing nystagmus in the left eye)

26
Q

lesion in MLF + PPRF

A

*1 and 1/2 syndrome
(LEFT MLF and PPRF lesion:
-looking right: right eye will abduct to the R, left eye gets stuck at midline
-looking left: neither eye will move past midline)

27
Q

lateral medullary syndrome

A

*PICA stroke
*contralateral sensory loss in the body
*ipsilateral sensory loss in the face
*hoarseness and dysphagia
*ipsilateral Horner’s
*ipsilateral ataxia
*NO motor weakness
*hiccups

28
Q

medial pontine syndrome

A

*paramedian branches of the basilar stroke
*contralateral weakness
*contralateral vibration and proprioception loss
*weakness of ipsilateral eye abduction

29
Q

lateral pontine syndrome

A

*AICA stroke
*ipsilateral facial weakness (upper and lower face b/c LMN lesion)
*ipsilateral gaze palsy
*ipsilateral deafness/hearing loss
*nausea/vertigo
*ipsilateral face numbness
*ipsilateral ataxia
*contralateral numbness of limbs

30
Q

complete, bilateral pontine lesion

A

*locked-in syndrome
*comatose
*quadriparesis
*small, pinpoint pupils
*complete horizontal gaze palsy

31
Q

dorsal midbrain syndrome (Parinaud)

A

*caused by pressure upon the superior colliculus and pre-tectal area
*paralysis of vertical gaze (inability to look up)
*light-near dissociation (loss of pupillary response to light, but retained pupil constriction with convergence)
*convergence-retraction nystagmus upon attempted up-gaze

32
Q

Weber’s syndrome (ventro-medial midbrain)

A

*ipsilateral 3rd nerve palsy (eye down + out and dilated)
*contralateral hemiparesis (weakness - including face)

33
Q

Benedickt syndrome (paramedian midbrain)

A

*ipsilateral 3rd nerve palsy
*contralateral ataxia
*contralateral loss of touch/vibration

34
Q

localization for: pure motor hemiparesis lacunar stroke

A

*internal capsule (or ventral pons)

35
Q

localization for: pure sensory lacunar stroke

A

*thalamus (if all sensory modalities)

36
Q

localization for: clumsy-hand, dysarthria lacunar stroke

A

pons or internal capsule

37
Q

localization for: sensorimotor lacunar stroke

A

thalamus + internal capsule

38
Q

localization for: ataxic hemiparesis lacunar stroke

A

frontal lobe, in white matter

Neuro Exam 2 (24 decks)

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