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Vascular Neurology EK > Common presentations and Lesions > Flashcards

Common presentations and Lesions Flashcards

1
Q

Ipsilateral third nerve palsy and contralateral hemiplegia

A

Weber’s syndrome (midbrain lesion)

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2
Q

Ipsilateral third nerve palsy and contralateral involuntary movements

A

Benedikt’s Syndrome (lesion in the ventral portion of the mesencephalic tegmentum)

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3
Q

Ipsilateral third nerve palsy and contralateral ataxia and tremor

A

Claude’s syndrome (lesion in the dorsal portion of the mesencephalic tegmentum)

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4
Q

Ipsilateral seventh nerve palsy with contralateral hemiplegia

A

Millard-Gubler syndrome (lesion in the pons)

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5
Q

Limited upward gaze, convergence retraction nystagmus, light-near dissociation, lid retraction and skew deviation of the eyes

A

Parinaud’s syndrome (lesion in the quadrigmeminal plate)

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6
Q

Quadriplegia, inability to speak, limited horizontal gaze, with preserved consciousness, vertical gaze and blinking

A

Locked-in syndrome

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7
Q

Vertigo, nystagmus, nausea, hiccups, hoarseness, dysphagia, ipsilateral paralysis of the palate and vocal cord, decreased gag reflex, impaired sensation on the ipsilateral hemiface, loss of sensation to pain and temperature in the contralateral hemibody, ipsilateral ataxia and lateropulsion, and ipsilateral Horner’s syndrome

A

Wallenberg’s syndrome: caused by a lateral medullary infarction (associated with posterior inferior cerebellar artery or vertebral artery occlusion)

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8
Q

Ipsilateral hearing loss, vertigo, ipsilateral ataxia, ipsilateral Horner’s syndrome, sensory deficits in the ipsilateral hemiface and contralateral hemibody

A

Anterior inferior cerebellar artery infarct

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9
Q

Contralateral hemibody sensory loss with subsequent development of pain, allodynia, and parasthesia

A

Dejerine- Roussy syndrome, results from a thalamic lesion

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10
Q

Finger agnosia, right left disorientation, agraphia and acalculia

A

Gerstmann’s Syndrome - dominant parietal lobe infarct

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11
Q

Normal variant with vascular supply to both medial thalami

A

Artery of percheron

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12
Q

Deep branch from the ACA that supplies anterior limb of the internal capsule, inferior part of head of caudate nucleus, and anterior part of globus pallidus

A

recurrent artery of Heubner

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13
Q

Caused by chronic hypertension, and associated with the pathogenesis of lacunar strokes

A

Lipohyallinosis

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14
Q

Infarct between two vascular territories produces the “person in a barrel” syndrome characterized by proximal weakness

A

Watershed infarcts

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15
Q

Behavioural abnormalities, altered level of consciousness, and abnormalities of ocular motion

A

Top of basilar syndrome -

Infarct in the posterior circulation from thrombus lodging in the distal basillar

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16
Q

right hemiparesis, right homonoymous hemianopia and aphasia

A

Left MCA syndrome

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17
Q

Left hemiparesis, left homonymous hemianopia and left hemineglect

A

Right MCA syndrome

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18
Q

Thalamus, contralateral hemisensory loss

A

pure sensory lacunar syndrome

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19
Q

Posterior limb of internal capsule, contralateral motor deficits. Also described with ventral pons lacunes

A

Pure motor lacunar syndrome

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20
Q

Paramedian pons “clumsy hand” and dysarthria

A

clumsy hand dysarthria lacunar syndrome

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21
Q

Pons, midbrain or internal capsule, weakness with ataxia out of proportion to weakness

A

Ataxic hemiparesis lacunar syndrome

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22
Q

NOTCH3

A

CADASIL: cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

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23
Q

Dilated thin-walled vessels, with no smooth muscle of elastic fibers, and no intervening brain parenchyma (popcorn appearance on MRI)

A

Cavernous malformation

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24
Q

Thin walled venous structure with normal intervening brain tissue

A

venous angioma

25
Q

Abnormally dilated capillaries, normal intervening brain tissue

A

Capillary telangiectasia

26
Q

Nidus, with arteries and veins communicating without intervening normal capillary bed in between

A

Arteriovenous malformation

27
Q

Haemorrhage in the putamen, caudate, thalamus, pons, cerebellum, and deep white matter - associated with lipohyalinosis and charcot bouchard microaneurysms

A

hypertensive intracranial haemorrhage

28
Q

Lobar haemorrhages
Multiple microhaemorrhages on MRI gradient echo
Congo-red positive amyloid material, seen as apple-green birefringence with polarized light

A

cerebral amyloid angiopathy

29
Q

“Puff of smoke”

A

Extensive collateral circulation seen in Moyamoya disease, in which there is bilateral stenosis of the distal internal carotid arteries and intracranial arteries of the circle of Willis

30
Q

Internal carotid artery

A

Ipsilateral retinal ischemia (amaurosis)

Sensorimotor dysfunction similar to involvement of middle and anterior cerebral artery territories

31
Q

Middle cerebral artery, M1 segment

A

contralateral face and arm (more than leg) weakness
Aphasia (dominant hemisphere)
Contralateral sensory loss
Cortical sensory loss (nondominant hemisphere)
Contralateral visual field defect
gaze deviation ipsilateral to lesion

32
Q

Middle cerebral artery, anterior devision

A 
Contralateral face and arm weakness
Broca aphasia (dominant hemisphere)
33
Q

Middle cerebral artery, posterior division

A 
contralateral sensory loss
Wernickes aphasia (dominant hemisphere)
Gerstmann syndrome (dominant hemisphere)
Cortical sensory loss or neglect (non-dominant hemisphere)
Contralateral visual field defect
34
Q

Anterior cerebral artery

A

Contralateral leg weakness
Contralateral leg sensory loss
Apraxia
Abulia (bilateral)

35
Q

Anterior choroidal artery

A

Contralateral homonymous hemianopia (lateral geniculate body)
Contralateral facial, arm, leg weakness (posterior limb of internal capsule)
Contralateral facial, arm, leg sensory loss (thalamus)

36
Q

Posterior cerebral artery, precommunicating part

A 
contralateral sensory loss (thalamus)
Cognitive dysfunction (thalamus)
Thalamic aphasia (rarely)
Visual dysfunction as for postommunicating segment
37
Q

Posterior cerebral artery, posterior communicating part

A

contralateral homonymous hemianopia

Visual agnosias

38
Q

Posterior inferior cerebellar artery

A 
Horners
Ipsilateral hemiataxia
Ipsilateral palatal weakness
Hoarse voice
Decreased pain and temperature on ipsilateral portion of face and contralateral limbs
39
Q

Anterior inferior cerebellar artery

A

ipsilateral deafness
Ipsilateral facial weakness (LMN)
Ipsilateral hemiataxia
Contralateral sensory loss in limb

40
Q

Superior cerebellar artery

A

Ipsilateral ataxia
Decreased sensation contralaterally
Diplopia

41
Q

Basilar perforators, median and paramedian pontine perforators

A

contralateral limb weakness if unilateral, quadriparesis if bilateral
Hemiataxia may develop (crossing pontocerebellar fibers)
CNVI and VII (affecting nuclei or nerve fibers) palsies
Internuclear opthalmoplegia

42
Q

Midbrain basilar, posterior cerebral artery perforators

A

Ipsilateral nuclear or fascicular CN III palsy
Contralateral facial, arm, leg weakness (corticospinal tracts)
Rubral tremor (red nucleus) may develop
Ataxia (deccusation of superior cerebellar peduncle) may occur

43
Q

Anterior spinal and vertebral perforators to median and paramedian medulla

A

Ipsilateral tongue weakness (CNXII nucleus or nerve fibers)
Contralateral arm and leg have reduced vibration sensation and proprioception (medial lemniscus)
Contralateral arm and leg weakness (medullary pyramids)

44
Q

Weber syndrome

A

Medial midbrain
PCA perforators
Contralateral hemiparesis (cerebral peduncle)
Isilateral CN III palsy (fascicles of CN III)
Imparied ipsilateral pupillary reflex (CNIII) and dilated pupil

45
Q

Benedikt Syndrome

A

Midbrain tegmentum
PCA perforators
Ipsilateral CN III palsy, usually with dilated pupil
Contralateral involuntary movements (red nucleus, subthalamic nucleus)

46
Q

Claude syndrome

A

Midbrain tegmentum (dorsal)
PCA perforators
Ipsilateral CN III palsy (CN III fascicles)
contralateral hemiataxia and dysmetria (dentatothalamic fibers within the superior cerebellar peduncle)
Contralateral tremor (red nucleus)

47
Q

Nothnagel syndrome

A

Midbrain
PCA perforators
Ipsilateral III CN palsy
Contralateral hemiataxia (dentothalamic fibers in superior cerebellar peduncle)

48
Q

Millard Gubler Syndrome

A

Ventral Pons
Basilar artery perforators, median and paramedian perforators
ipsilateral lower motor neuron facial paralysis (CNVII)
Ipsilateral abducens paralysis (CNVI fibres)
Contralateral hemiparesis (corticospinal tract in basis pontis)

49
Q

Foville syndrome

A

Dorsal pons tegmentum
Basilar artery perforators
Ipsilateral LMN facial paralysis (nucleus or fascicles of CN VII)
Ipsilateral gaze paralysis (nucleu abducens palsy)
Contralateral hemiparesis (corticospinal tract in basis pontis)

50
Q

Ventral pontine syndrome

A

ventral pons
Basilar artery, paramedian perforators
Ipsilateral CN VI palsy
Contralateral hemiparesis (corticospinal tract in basis pontis)

51
Q

Marie-Foix syndrome

A

Base of pons
Basilar artery perforators
Ipsilateral cerebellar ataxia (corticopontocerebellar fibers)
Contralateral hemiparesis (corticospinal tract in basis pontis)
Variable contralateral decrfease in pain and temperature sensation (spinothalamic tract involvement)

52
Q

Wallenberg Syndrome

A

Lateral medulla
PICA
Ipsilateral hemiataxia (inferior cerebellar peduncle)
Dysphagia, hoarseness, ipsilateral palatal weakness (nucleus ambiguus),
Horner syndrome (sympathetic)
Decreased in pain and temperature sensation (spinal tract and nucleus of CN V and lateral spinothalamic tract) on ipsilateral portion of face, contralateral portion of body

53
Q

Dejerine syndrome

A

Medial medulla
Vertebral artery perforators, anterior spinal artery
Contralateral hemiparesis (medullary pyramid)
Contralateral decrease in vibration or proprioception sensation in limbs (medial lemniscus)
Ipsilateral CN XII palsy

54
Q

Internal capsule

A

pure motor hemiparesis (contralateral facial, arm, leg)

55
Q

corona radiata

A

pure motor hemiparesis (contralateral facial, arm, leg)

56
Q

Thalamus (ventral posterolateral and posteromedial nuclei)

A

pure sensory stroke contralateral facial, arm, leg sensory loss

57
Q

Thalamocapsular

A

Sensorimotor stroke - contralateral facial, arm, leg weakness and contralateral facial, arm, leg sensory loss

58
Q

Basis pontis, talamocapsular, corona radiata

A

ataxic hemiparesis stroke - hemiataxia and hemiparesis on same side of body

59
Q

Basis pontis

A

Clumsy hand dysarthria - facial weakness, dysarthria, slight hemiparesis

Vascular Neurology EK (3 decks)

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