Cerebral and Brainstem Strokes

Question 1

MCA Syndrome

Answer 1

• contralateral hemiplegia face, UE>LE
• contralateral hemisensory loss, UE>LE
• homonymous hemianopsia

Question 2

MCA syndrome- other localizing features

Answer 2

• motor speech involvement- fluent, nonfluent global or conduction aphasia
• perceptual deficit (non dominant hemisphere)
• loss of conjugate gaze to the opposite side
• sensory ataxia

Question 3

ACA Syndrome

Answer 3

• contralateral hemiplegia (LE>UE)
• contralateral hemisensory loss (LE>UE)
• urinary incontinence
• problems with bimanual tasks
• apraxia

Question 4

ACA Syndrome - other localizing features

Answer 4

• patients may be less mobile
• patients may be less verbal

Question 5

PCA Syndrome

Answer 5

• contralateral sensory loss
• involuntary movements: choreoathetosis, tremor, hemiballismus
• transient contralateral hemiparesis
• homonymous hemianopsia

Question 6

PCA Syndrome - other localizing features

Answer 6

• visual agnosia
• memory deficit
• dyslexia
• central pain
• Weber’s syndrome
• Oculomotor n palsy

Question 7

Internal capsule lesion - posterior limb

Answer 7

Lacunar Stroke (pure motor)
- contralateral hemiplegia UE and LE
- no aphasia
- visual field deficit rare

Question 8

Midbrain lesion

Answer 8

• contralateral hemiplegia
• contralateral CN III palsy

Question 9

Medial pontine syndrome - occlusion of paramedian branch of basilar artery

Answer 9

ipsilateral to lesion:
- cerebellar ataxia, nystagmus
- paralysis of conjugate gaze
- diplopia
Contralateral to lesion:
- hemiparesis UE/LE
- impaired sensation

Question 10

Lateral pontine syndrome - AICA occlusion

Answer 10

Ipsilateral to lesion:
- cerebellar: ataxia, nystagmus, vertigo
- facial paraysis
- paralysis of conjugate gaze to the side of the lesion
- deafness, tinitus
- impaired facial sensation
Contralateral to lesion:
- impaired pain and temp sensation half of body

Question 11

Medial Medullary Syndrome - occlusion of vertebral artery, medullary branch

Answer 11

Ipsilateral to lesion:
- paralysis of half of tongue
Contralateral to lesion:
- hemiplegia UE and LE
- impaired sensation

Question 12

Lateral Medullary Syndrome - occlusion of PICA/vertebral artery

Answer 12

Ipsilateral to lesion:
- cerebellar symptoms
- loss of pain and temp to afce
- sensory loss UE, trunk or LE
- horner’s syndrome
- Dysphagia
Contralateral to lesion
- loss of pain and temp to body and face
- impaired speech