Common presentations and Lesions Flashcards
Ipsilateral third nerve palsy and contralateral hemiplegia
Weber’s syndrome (midbrain lesion)
Ipsilateral third nerve palsy and contralateral involuntary movements
Benedikt’s Syndrome (lesion in the ventral portion of the mesencephalic tegmentum)
Ipsilateral third nerve palsy and contralateral ataxia and tremor
Claude’s syndrome (lesion in the dorsal portion of the mesencephalic tegmentum)
Ipsilateral seventh nerve palsy with contralateral hemiplegia
Millard-Gubler syndrome (lesion in the pons)
Limited upward gaze, convergence retraction nystagmus, light-near dissociation, lid retraction and skew deviation of the eyes
Parinaud’s syndrome (lesion in the quadrigmeminal plate)
Quadriplegia, inability to speak, limited horizontal gaze, with preserved consciousness, vertical gaze and blinking
Locked-in syndrome
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
Wallenberg’s syndrome: caused by a lateral medullary infarction (associated with posterior inferior cerebellar artery or vertebral artery occlusion)
Ipsilateral hearing loss, vertigo, ipsilateral ataxia, ipsilateral Horner’s syndrome, sensory deficits in the ipsilateral hemiface and contralateral hemibody
Anterior inferior cerebellar artery infarct
Contralateral hemibody sensory loss with subsequent development of pain, allodynia, and parasthesia
Dejerine- Roussy syndrome, results from a thalamic lesion
Finger agnosia, right left disorientation, agraphia and acalculia
Gerstmann’s Syndrome - dominant parietal lobe infarct
Normal variant with vascular supply to both medial thalami
Artery of percheron
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
recurrent artery of Heubner
Caused by chronic hypertension, and associated with the pathogenesis of lacunar strokes
Lipohyallinosis
Infarct between two vascular territories produces the “person in a barrel” syndrome characterized by proximal weakness
Watershed infarcts
Behavioural abnormalities, altered level of consciousness, and abnormalities of ocular motion
Top of basilar syndrome -
Infarct in the posterior circulation from thrombus lodging in the distal basillar
right hemiparesis, right homonoymous hemianopia and aphasia
Left MCA syndrome
Left hemiparesis, left homonymous hemianopia and left hemineglect
Right MCA syndrome
Thalamus, contralateral hemisensory loss
pure sensory lacunar syndrome
Posterior limb of internal capsule, contralateral motor deficits. Also described with ventral pons lacunes
Pure motor lacunar syndrome
Paramedian pons “clumsy hand” and dysarthria
clumsy hand dysarthria lacunar syndrome
Pons, midbrain or internal capsule, weakness with ataxia out of proportion to weakness
Ataxic hemiparesis lacunar syndrome
NOTCH3
CADASIL: cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
Dilated thin-walled vessels, with no smooth muscle of elastic fibers, and no intervening brain parenchyma (popcorn appearance on MRI)
Cavernous malformation
Thin walled venous structure with normal intervening brain tissue
venous angioma
Abnormally dilated capillaries, normal intervening brain tissue
Capillary telangiectasia
Nidus, with arteries and veins communicating without intervening normal capillary bed in between
Arteriovenous malformation
Haemorrhage in the putamen, caudate, thalamus, pons, cerebellum, and deep white matter - associated with lipohyalinosis and charcot bouchard microaneurysms
hypertensive intracranial haemorrhage
Lobar haemorrhages
Multiple microhaemorrhages on MRI gradient echo
Congo-red positive amyloid material, seen as apple-green birefringence with polarized light
cerebral amyloid angiopathy
“Puff of smoke”
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
Internal carotid artery
Ipsilateral retinal ischemia (amaurosis)
Sensorimotor dysfunction similar to involvement of middle and anterior cerebral artery territories
Middle cerebral artery, M1 segment
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
Middle cerebral artery, anterior devision
Contralateral face and arm weakness Broca aphasia (dominant hemisphere)
Middle cerebral artery, posterior division
contralateral sensory loss Wernickes aphasia (dominant hemisphere) Gerstmann syndrome (dominant hemisphere) Cortical sensory loss or neglect (non-dominant hemisphere) Contralateral visual field defect
Anterior cerebral artery
Contralateral leg weakness
Contralateral leg sensory loss
Apraxia
Abulia (bilateral)
Anterior choroidal artery
Contralateral homonymous hemianopia (lateral geniculate body)
Contralateral facial, arm, leg weakness (posterior limb of internal capsule)
Contralateral facial, arm, leg sensory loss (thalamus)
Posterior cerebral artery, precommunicating part
contralateral sensory loss (thalamus) Cognitive dysfunction (thalamus) Thalamic aphasia (rarely) Visual dysfunction as for postommunicating segment
Posterior cerebral artery, posterior communicating part
contralateral homonymous hemianopia
Visual agnosias
Posterior inferior cerebellar artery
Horners Ipsilateral hemiataxia Ipsilateral palatal weakness Hoarse voice Decreased pain and temperature on ipsilateral portion of face and contralateral limbs
Anterior inferior cerebellar artery
ipsilateral deafness
Ipsilateral facial weakness (LMN)
Ipsilateral hemiataxia
Contralateral sensory loss in limb
Superior cerebellar artery
Ipsilateral ataxia
Decreased sensation contralaterally
Diplopia
Basilar perforators, median and paramedian pontine perforators
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
Midbrain basilar, posterior cerebral artery perforators
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
Anterior spinal and vertebral perforators to median and paramedian medulla
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)
Weber syndrome
Medial midbrain
PCA perforators
Contralateral hemiparesis (cerebral peduncle)
Isilateral CN III palsy (fascicles of CN III)
Imparied ipsilateral pupillary reflex (CNIII) and dilated pupil
Benedikt Syndrome
Midbrain tegmentum
PCA perforators
Ipsilateral CN III palsy, usually with dilated pupil
Contralateral involuntary movements (red nucleus, subthalamic nucleus)
Claude syndrome
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)
Nothnagel syndrome
Midbrain
PCA perforators
Ipsilateral III CN palsy
Contralateral hemiataxia (dentothalamic fibers in superior cerebellar peduncle)
Millard Gubler Syndrome
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)
Foville syndrome
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)
Ventral pontine syndrome
ventral pons
Basilar artery, paramedian perforators
Ipsilateral CN VI palsy
Contralateral hemiparesis (corticospinal tract in basis pontis)
Marie-Foix syndrome
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)
Wallenberg Syndrome
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
Dejerine syndrome
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
Internal capsule
pure motor hemiparesis (contralateral facial, arm, leg)
corona radiata
pure motor hemiparesis (contralateral facial, arm, leg)
Thalamus (ventral posterolateral and posteromedial nuclei)
pure sensory stroke contralateral facial, arm, leg sensory loss
Thalamocapsular
Sensorimotor stroke - contralateral facial, arm, leg weakness and contralateral facial, arm, leg sensory loss
Basis pontis, talamocapsular, corona radiata
ataxic hemiparesis stroke - hemiataxia and hemiparesis on same side of body
Basis pontis
Clumsy hand dysarthria - facial weakness, dysarthria, slight hemiparesis
