Cerebrovascular Diseases

Question 1

The middle cerebral artey (MCA) in most patients divides into…?

Answer 1

Superior and Inferior Divisions

Question 2

The Superior Division supllies the…?

Answer 2

Frontal and Superior Parietal Cortex

Question 3

The Inferior Division supplies the…?

Answer 3

Inferior Parietal and Temporal Cortex

Question 4

Occlusion of the entire MCA (with limited distal collaterals) presents with..?

Answer 4

Contralateral Hemiparesis and Hemianesthesia,Homonymous Hemianopsia, Gaze Preference to the ipsilateral side (for a day or two), dysarthria and global aphasia (with dominant hemisphere involvement)

Question 5

Occlusion of a lenticulostriate vessel produces..?

Answer 5

Small-vessel (lacunar) stroke within the internal capsule (either pure motor stroke or sensory-motor stroke contralateral to the lesion)

Question 6

The anterior cerebral artery (ACA) is divided into…?

Answer 6

The precommunal (A1) segment and the postcommunal (A2) vessel

Question 7

The branches of the A1 segment supplly…?

Answer 7

Ant. limb of int. capsule
Ant. perforating substance
Amygdala
Ant. Hypothalamus
Inf part of the head of the caudate nucleus

Question 8

With occlusion of both A2 segments (e.g. due to contralateral A1 atresia) the occlusion may affect both hemispheres.Symptoms include…?

Answer 8

Profound abulia (a delay in verbal and motor response)
Paraparesis or Quadreparesis with bilateral pyramidal signs
Urinary Incontinence

Question 9

The anterior choroidal artery arises from the internal carotid artery and supplies…?

Answer 9

Posterior limb of the internal capsule and the white mater posterolateral to it (occlusion may lead to contralateral hemiplegia,hemianesthesia (hypesthesia) and homonymous hemianopsia)

Question 10

Describe the origins of the posterior cerebral arteries (PCAs)

Answer 10

In 75% of cases,both PCAs arise from the bifurcation of the basilar artery; in 20%, one has its origin from the ipsilateral internal carotid artery via the posterior communicating artery; in 5% both originate from the respective ipsilateral internal carotid arteries

Question 11

The PCA is divided in P1 and P2 divisions. P1 syndrome includes…?

Answer 11

Third nerve palsy with contralateral ataxia (Claude’s syndrome) or with contralateral hemiplegia (Weber’s syndrome). Ataxia due to red nucleus or dentatorubrothalamic tract involvement, hemiplegia due to cerebral peduncle involvement. With subthalamic nucleus involvement, contralateral hemibalismus may occur

Question 12

Occlusion of the distal (P2) segment of the PCA causes…?

Answer 12

Infarction of the medial temporal and occipital lobes

Question 13

Hallmarks of an occluded top of the basilar artery include…?

Answer 13

Sudden onset of bilateral signs, including ptosis, pupillary asymmetry or lack of reaction to light, and somnolence. Posturing and myoclonic jerks that simulate seizure are often evident.

Question 14

The posterior inferior cerebellar artery (PICA) supplies…?

Answer 14

The lateral medulla and in its distal branches the inferior surface of the cerebellum

Question 15

The lateral medullary syndrome (AKA Wallenberg’s syndrome) includes…? (usually due to occlusion of the ipsilateral vertebral artery or PICA)

Answer 15

Vertigo
Numbess of the ipsilateral face and cont. limbs
Diplopia
Hoarseness
Dysarthria
Dysphagia
Horner’s Syndrome
(ipsilateral upper motor neuron FACIAL weakness can also occur)
Hemiparesis is NOT a typical finding of vertebral artery occlusion

Question 16

Cerebellar infarction can lead to…?

Answer 16

Respiratory arrest due to increased ICP (displacement of the brainstem from cerebellar edema will also cause resp. and hemodynamic instabillity)

Question 17

A ‘‘locked-in’’ state of preserved consciousness with quadriplegia and cranial nerve signs suggests..?

Answer 17

Complete pontine and lower midbrain infarction

Question 18

What percentage of strokes remain unexplained ?

Answer 18

Nearly 30%

Question 19

Which studies are necessary prior to IV rtPA administration ?

Answer 19

Capillary blood glucose and brain imaging

Question 20

Emboli from the heart most often lodge in…?

Answer 20

Intracranial carotid artery, MCA, PCA or one of their branches

Question 21

small vessel stroke account for ?% of strokes

Answer 21

about 20% (hypertension and age are the principal risk factors)