Neuro Flashcards
Superior MCA Stroke
- Contralateral weakness (Face/UL > Leg)
- Contralateral sensory loss (Face/UL > Leg)
- Non-dominant hemisphere –> Hemineglect
- Dominant hemisphere –> Broca’s (Non-fluent) Aphasia [Can’t speak]
Inferior MCA stroke
- Contralateral homonymous hemianopia
- Contralateral upper quadrant anopia
- Non-dominant hemisphere –> Constructional apraxia
- Dominant hemisphere –> Wernicke’s [Fluent] aphasia “word salad”
Pure upper limb monoparesis
Arm or hand weakness alone
Superficial branches of anterior (superior) MCA or, less frequently posterior (inferior) MCA divisions.
Uncommon.
Dominant-hemisphere parietal syndrome
Gerstmann’s syndrome
Agraphia
Alexia
Finger agnosia
Left/right confusion
Mostly MCA supply
Non-dominant parietal syndrome
Inattention - visual or tactile
Lack of concern
Anosognisia (denial of neurological deficit)
Emotional speech
Motor impersistence: spatial disorientation, constructional apraxia, dressing apraxis
Prospagnosia (can’t recognises faces) — temporal lobe
Heubner’s artery
Supplies the head of the caudate.
Heubner’s artery is the largest of the lenticulostriate arteries.
It supplies the anteromedial part of the head of the caudate and the anteroinferior internal capsule.
Stroke may be:
- Silent
- Hemiparesis of the face and upper limb > leg
- Hemibalismus
Anterior choroidal artery
- The anterior choroidal artery may either branch from the ICA or from the MCA
- Anterior choroidal artery supplies the posterior internal capsule, thalamus and optic radiation
- Stroke would present with:
- Contralateral hemiplegia
- Hemianaesthesia
- Homonymous hemianopia (optic radiation)
PCA
Supplies the occipital lobe
MCA
Supplies the lateral parietal lobe; lateral frontal lobe; temporal lobe
Complete PCA infarct
Contralateral homonymous hemianopia
in PCA infarcts, visual field defects are often the only neurological abnormality.
The combination of hemisensory loss and hemianopia without paralysis is virtually diagnostic of PCA infarct.
Left PCA territory
- Alexia without agraphia
- Associative visual agnosia - difficulty understanding the nature and use of objects presented visually
- Preserved somatic perception
May also find:
- Anomic aphasia
- Transcortical sensory aphasia (if thalamus is involved – substitute similar sounds, repetition is affected)
- Gerstmann syndrome
Right PCA territory
- Prosopagnosia - difficulty recognising familiar faces
- Spatial disorientation – disorientation to place, inability to recall routes
- Visual neglect more common after lesions of R > L.
PCA syndromes (x7)
- Alexia without agraphia
- Balint syndrome
- Claude syndrome
- Cortical blindness (Anton syndrome)
- Unilateral occipital
- Thalamic pain syndrome (Dejerine-Roussy Syndrome)
- Weber syndrome
ACA
ACA supplies:
- Medial frontal lobe
- Medial parietal lobe
- Anterior corpus callosum, basal ganglia, internal capsule
ACA stroke
- Contralateral paralysis foot/leg > UL/face
- Cortical sensory loss of foot and leg (loss of discriminative sensation)
Frontal lobe→
- Urinary incontinence
- Contralateral primitive reflexes (frontal lobe usually inhibits primite reflexes)
- Abulia (lack of motivation to perform a task)
- Emotional lability
Difficulty walking due to inability to plan gait
Very small ACA stroke could present with foot drop!
Lateral medullary syndrome
= Wallenberg Syndrome
Vascular: Vertebral artery (PICA less common)
Presentation:
- Ipsilateral Horner’s (descending sympathetic tract involvement)
- Ipsilateral vertigo, nausea, nystagmus (Vestibular nucleus)
- Ipsilateral horseness, dysphagia (nucleus ambiguus)
- Ipsilateral ataxia/gait ataxia (restiform body, cerebellum)
- Contralateral hemisensory loss (spinothalamic tract)
- Hiccups
Medial medullary syndrome
Vascular: Anteriomedial vertebral artery; anterior spinal artery; basilar artery
Syndrome:
- Contralateral upper and lower extremity weakness (pyramidal)
- Contralateral hemisensory loss - vibration/proprioception (Medial lemniscus – Dorsal column)
- Ipsilateral tongue weakness +/- atrophy (deviates TOWARDS lesion when tongue is poked out)
PICA cerebellar infarction
Vermis (vertigo, nystagmus, truncal lateropulsion)
Full PICA → oedema and mass effect
Basilar artery
The basilar artery supplies most of the midbrain.
Thalamus; temporal lobe; occipital lobe; midbrain
Rostral = Tip of the basilar
Vertical gaze abnormalities, especially upgaze
Loss of alertness
Convergence
Inferior medial pontine syndrome
Vascular: Basilar artery - paramedian and short circumferential branches
Presentation:
- Contralateral UL and LL weakness (corticospinal tract)
- Ipsilateral face weakness (entire side) (CNVII Nucleus)
- Ipsilateral lateral gaze weakness (PPRF, CNVI Nucleus)
Alexia without agraphia. Where is the lesion?
PCA - collosal branches of PCA
Affects left occipital region plus splenium of corpus collosum
Pure word blindness, can write but cannot read
Contralateral visual loss
Alexia (splenium of corpus collosum)
Balint syndrome - what/where is the lesion
Bilateral posterior cerebral arteries.
Bilateral parietal-occipital lobes
Bilateral loss of voluntary but not reflex eye movements
Bilateral optic ataxia - poor visual-motor coordination
Bilateral asimultagnosia - inability to understand visual objects
Claude syndrome
Proximal branches of PCA + paramedial branches of upper basilar.
Midbrain tementum (red nucleus)
Ipsilateral eye movement weakness (occulmotor palsy)
Contralateral ataxia.- arm and leg (cerebellar tracts)
Contralateral tremor
Anton sydnrome
What is it and where is the lesion?
Anton syndrome = cortical blindness
Bilateral posterior cerebral arteries
Bilateral occipital lobes
Bilateral visual loss
Unawarness/denial of blindness
Unilateral occipital - where is the lesion?
PCA
Contralateral visual loss
Homoymous hemianopia (optic pathway, calcarin cortex)
Thalamic pain syndrome
PCA - penetrating branches to thalamus
Contralateral hemisensory loss - all modalities
Contralateral hemi-body pain
AKA Dejerine-Roussy Syndrome
Weber syndrome - what is it and where is the lesion?
PCA - penetrating arteries to midbrain
Contralateral weakness - upper and lower limb (corticospinal trat)
Ipsilateral lateral gaze weakness (CNIII)
Friedrecih’s Ataxia - Genetic mutation?
GAA triplet repeat
“GAA can’t walk!”
Fragile X syndrome - Genetic mutation?
CGG
“X Gon’ CGGive it to ya”
Huntington’s disease - ?Genetic mutation
CAG repeat
“we don’t hunt in CAGes”
Myotonic dystrophy - ?Genetic mutation
CTG
“CTG rhymes with dys-tro-phy”
