Locate the Lesion

Question 1

Dominant (Left) MCA - Superior Division

Answer 1

Supplies: Lateral frontal lobe, superior parietal lobe

Deficits: R face and upper arm of the upper motor type, Non-fluent aphasia (Broca’s), may have R face and arm cortical-type sensory loss.

Question 2

Dominant (Left) MCA - Inferior Division

Answer 2

Supplies: Lateral temporal lobe, inferior parietal lobe

Deficits: Fluent (Wernicke’s aphasia), Right visual field deficit (homonymous hemianopia), pt may initially be confused or crazy, mild right sided weakness especially at onset, motor findings absent

Question 3

Dominant (Left) MCA - Deep Territory

Answer 3

Deficits: Right pure motor hemiparesis of UMN

*Larger infarcts produce “cortical” deficits - aphasia

Question 4

Dominant (Left) MCA - Stem

Answer 4

Deficits: R hemiplegia, R hemianesthesia, R homonymous hemianopia, global aphasia, left gaze preference especially at onset

Question 5

Non-Dominant (Right) MCA - Superior Division

Answer 5

Supplies: lateral frontal lobe, superior parietal lobe

Deficits: L face and arm weakness UMN type, L hemineglect (variable), some L face and arm cortical-type sensory loss, gaze preference to the R

Question 6

Non-Dominant (Right) MCA - Inferior Division

Answer 6

Supplies: Lateral temporal lobe, inferior parietal lobe

Deficits: profound L hemineglect, L visual fields and somatosensory deficits (hemianopia), some L sided weakness may be present, R gaze preference

Question 7

Non-Dominant (Right) MCA - Deep Territory

Answer 7

Deficits: L pure motor hemiparesis of UMN type

*Larger infarcts may produce “cortical: deficits such as L hemineglect

Question 8

Non-Dominant (Right) MCA - Stem

Answer 8

Deficits: L hemiplegia, L hemianesthesia, L homonymous hemianopia, profound hemineglect, R gaze preference

Question 9

Dominant (Left) ACA

Answer 9

Supplies: Anterior and medial frontal and parietal lobes, internal capsule

Deficits: R leg weakness of UMN type, R leg cortical-type sensory loss, grasp reflex, frontal lobe behavioral abnormalities, transcortical aphasia, incontinence, muscle rigidity, gaze towards the L
*Larger infarcts can cause hemiplegia.

Question 10

Non-Dominant (Right) ACA

Answer 10

Supplies Anterior and medial frontal and parietal lobes, internal capsule

Deficits: L leg weakness of UMN type, left leg cortical-type sensory loss, grasp reflex, frontal lobe behavioral changes, L hemineglect,
*Larger infarcts may cause L hemiplegia

Question 11

Dominant (Left) PCA

Answer 11

Supplies: Midbrain, occipital lobe, medial/inferior temporal lobe

Deficits: R homonymous hemianopia

• Larger infarcts including thalamus and internal capsule - aphasia, R hemisensory loss, R hemiparesis
• Extension to the selenium of the corpus callous can cause alexia without agraphia

Question 12

Non-Dominant (Right) PCA

Answer 12

Supplies: Midbrain, occipital lobe, medial and inferior temporal lobe

Deficits: L homonymous hemianopia
*Larger infarcts including thalamus and internal capsule may cause L hemisensory loss and L hemiparesis