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LBH 2022 > Neuro > Flashcards

Neuro Flashcards

1
Q

Superior MCA Stroke

A
  • 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]
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2
Q

Inferior MCA stroke

A
  • Contralateral homonymous hemianopia
  • Contralateral upper quadrant anopia
  • Non-dominant hemisphere –> Constructional apraxia
  • Dominant hemisphere –> Wernicke’s [Fluent] aphasia “word salad”
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3
Q

Pure upper limb monoparesis

A

Arm or hand weakness alone
Superficial branches of anterior (superior) MCA or, less frequently posterior (inferior) MCA divisions.
Uncommon.

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4
Q

Dominant-hemisphere parietal syndrome

A

Gerstmann’s syndrome

Agraphia
Alexia
Finger agnosia
Left/right confusion

Mostly MCA supply

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5
Q

Non-dominant parietal syndrome

A

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

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6
Q

Heubner’s artery

A

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
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7
Q

Anterior choroidal artery

A
  • 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)
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8
Q

PCA

A

Supplies the occipital lobe

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9
Q

MCA

A

Supplies the lateral parietal lobe; lateral frontal lobe; temporal lobe

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10
Q

Complete PCA infarct

A

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.

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11
Q

Left PCA territory

A
  • 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
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12
Q

Right PCA territory

A
  • Prosopagnosia - difficulty recognising familiar faces
  • Spatial disorientation – disorientation to place, inability to recall routes
  • Visual neglect more common after lesions of R > L.
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13
Q

PCA syndromes (x7)

A
  1. Alexia without agraphia
  2. Balint syndrome
  3. Claude syndrome
  4. Cortical blindness (Anton syndrome)
  5. Unilateral occipital
  6. Thalamic pain syndrome (Dejerine-Roussy Syndrome)
  7. Weber syndrome
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14
Q

ACA

A

ACA supplies:

  • Medial frontal lobe
  • Medial parietal lobe
  • Anterior corpus callosum, basal ganglia, internal capsule
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15
Q

ACA stroke

A
  • 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!

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16
Q

Lateral medullary syndrome

A

= 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
17
Q

Medial medullary syndrome

A

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)
18
Q

PICA cerebellar infarction

A

Vermis (vertigo, nystagmus, truncal lateropulsion)

Full PICA → oedema and mass effect

19
Q

Basilar artery

A

The basilar artery supplies most of the midbrain.

Thalamus; temporal lobe; occipital lobe; midbrain

20
Q

Rostral = Tip of the basilar

A

Vertical gaze abnormalities, especially upgaze

Loss of alertness

Convergence

21
Q

Inferior medial pontine syndrome

A

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)
22
Q

Alexia without agraphia. Where is the lesion?

A

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)

23
Q

Balint syndrome - what/where is the lesion

A

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

24
Q

Claude syndrome

A

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

25
Q

Anton sydnrome

What is it and where is the lesion?

A

Anton syndrome = cortical blindness

Bilateral posterior cerebral arteries

Bilateral occipital lobes

Bilateral visual loss

Unawarness/denial of blindness

26
Q

Unilateral occipital - where is the lesion?

A

PCA

Contralateral visual loss

Homoymous hemianopia (optic pathway, calcarin cortex)

27
Q

Thalamic pain syndrome

A

PCA - penetrating branches to thalamus

Contralateral hemisensory loss - all modalities

Contralateral hemi-body pain

AKA Dejerine-Roussy Syndrome

28
Q

Weber syndrome - what is it and where is the lesion?

A

PCA - penetrating arteries to midbrain

Contralateral weakness - upper and lower limb (corticospinal trat)

Ipsilateral lateral gaze weakness (CNIII)

29
Q

Friedrecih’s Ataxia - Genetic mutation?

A

GAA triplet repeat

“GAA can’t walk!”

30
Q

Fragile X syndrome - Genetic mutation?

A

CGG

“X Gon’ CGGive it to ya”

31
Q

Huntington’s disease - ?Genetic mutation

A

CAG repeat

“we don’t hunt in CAGes”

32
Q

Myotonic dystrophy - ?Genetic mutation

A

CTG

“CTG rhymes with dys-tro-phy”

LBH 2022 (10 decks)

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