Neuro - Anat & Phys (Effects of Strokes & Aneurysms)

Question 1

What are 3 main vessels in the anterior circulation of the brain?

Answer 1

(1) MCA (Middle cerebral artery) (2) ACA (Anterior cerebral artery) (3) Lenticulo-striate artery

Question 2

What are 4 major areas of the brain in the MCA territory?

Answer 2

(1) Motor cortex - upper limb and face (2) Sensory cortex - upper limb and face (3) Temporal lobe (Wernicke area) (4) Frontal lobe (Broca area)

Question 3

What symptoms are caused by a motor cortex (upper limb and face) lesion? To which artery would such a lesion apply?

Answer 3

Contralateral paralysis - upper limb and face; MCA

Question 4

What symptoms are caused by a sensory cortex (upper limb and face) lesion? To which artery would such a lesion apply?

Answer 4

Contralateral loss of sensation - upper limbs, and face; MCA

Question 5

What symptoms are caused by a Temporal lobe (Wernicke area) or Frontal lobe (Broca area) lesion? To which artery would such a lesion apply?

Answer 5

Aphasia if in dominant (usually) left hemisphere. Hemineglect if lesion affects nondominant (usually right) side; MCA

Question 6

What are 2 major areas of the brain in the ACA territory?

Answer 6

(1) Motor cortex - lower limb (2) Sensory cortex - lower limb

Question 7

What symptoms are caused by a motor cortex (lower limb) lesion? To which artery would such a lesion apply?

Answer 7

Contralateral paralysis - lower limb; ACA

Question 8

What symptoms are caused by a sensory cortex (lower limb) lesion? To which artery would such a lesion apply?

Answer 8

Contralateral loss of sensation - lower limb; ACA

Question 9

What are 2 major areas of the brain in the Lenticulo-striate artery territory?

Answer 9

(1) Striatum (2) Internal capsule

Question 10

What symptoms are caused by a striatum/internal capsule lesion? To which artery would such a lesion apply?

Answer 10

Contralateral hemiparesis/hemiplegia; Lenticulo-striate artery

Question 11

Which artery is a common location of lacunar infarcts? To what clinical condition are lacunar infarcts secondary?

Answer 11

Lenticulo-striate artery; Common location of lacunar infarcts, secondary to unmanaged hypertension

Question 12

What are 5 main vessels in the posterior circulation?

Answer 12

(1) ASA (Anterior spinal artery) (2) PICA (Posterior inferior cerebellar artery) (3) AICA (Anterior inferior cerebellar artery) (4) PCA (Posterior cerebral artery) (5) Basilar artery

Question 13

What are 3 major areas of the brain in the ASA territory?

Answer 13

(1) Lateral corticospinal tract (2) Medial lemniscus (3) Caudal medulla - hypoglossal nerve

Question 14

What symptoms are caused by a lateral corticospinal tract lesion? To which artery would such a lesion apply?

Answer 14

Contralateral hemiparesis - upper and lower limbs; ASA

Question 15

What symptoms are caused by a medial lemniscus lesion? To which artery would such a lesion apply?

Answer 15

Decreased contralateral proprioception; ASA

Question 16

What symptoms are caused by a caudal medulla (hypoglossal nerve) lesion? To which artery would such a lesion apply?

Answer 16

Ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally); ASA

Question 17

Is stroke associated with ASA commonly bilateral or unilateral?

Answer 17

Stroke commonly bilateral

Question 18

What infarct causes medial medullary syndrome? What are its associated symptoms, and why?

Answer 18

Caused by infarct of paramedian branches of ASA and vertebral arteries; Contralateral hemiparesis - upper and lower limbs (Corticospinal tract), Decreased contralateral proprioception (Medial lemniscus), Ipsilateral hypoglossal dysfunction - tongue deviates ipsilaterally (Caudal medulla - hypoglossal nerve)

Question 19

What is the major area of the brain in the PICA territory? What are 6 specific brain structures contained in this area?

Answer 19

Lateral medulla - (1) Vestibular nuclei (2) Lateral spinothalamic tract (3) Spinal trigeminal nucleus (4) Nucleus ambiguus (5) Sympathetic fibers (6) Inferior cerebellar peduncle

Question 20

What symptoms are caused by a lateral medulla lesion, and why? What is the name associated with this collection of symptoms? To which artery would such a lesion apply?

Answer 20

Vomiting, vertigo, nystagmus (vestibular nuclei); Decreased pain and temperature sensation from ipsilateral face (spinal trigeminal nucleus) and contralateral body (lateral spinothalamic tract); Dysphagia, hoarseness, decreased gag reflex (nucleus ambiguus); ipsilateral Horner syndrome (sympathetic fibers); ataxia, dysmetria (inferior cerebellar peduncle); Lateral medullary (Wallenbery) syndrome; PICA

Question 21

What brain structure’s effects are specific to PICA lesions?

Answer 21

Nucleus ambiguus effects are specific to PICA lesions; Think: “Don’t pick a (PICA) horse (hoarseness) that can’t eat (dysphagia).”

Question 22

What are 2 major areas of the brain in the AICA territory? What are important structures contained within each of these areas, if any?

Answer 22

(1) Lateral pons - cranial nerve nuclei; vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers (2) Middle and inferior cerebellar peduncles

Question 23

What symptoms are caused by a lateral pons lesion, and why? What is the name associated with this collection of symptoms? To which artery would such a lesion apply?

Answer 23

Vomiting, vertigo, nystagmus (vestibular nuclei); Paralysis of face, decreased lacrimation, salivation, decreased taste from anterior 2/3 of tongue, decreased corneal reflex (facial nucleus); Ipsilateral loss of pain and temperature of face, contralateral loss of pain and temperature of body (spinal trigeminal nucleus); Ipsilateral decreased hearing (cochlear nuclei); Ipsilateral Horner syndrome (sympathetic fibers); Lateral pontine syndrome; AICA

Question 24

What brain structure’s effects are specific to AICA lesions?

Answer 24

Facial nucleus effects are specific to AICA lesions; “Think: Facial droop means AICA’s pooped”

Question 25

What symptoms are caused by a lesion to middle and inferior cerebellar peduncles? To which artery would such a lesion apply?

Answer 25

Ataxia, dysmetria; AICA

Question 26

What major area(s) of the brain is (are) in the PCA territory?

Answer 26

Occipital cortex, visual cortex

Question 27

What symptoms are caused by a lesion to the occipital cortex/visual cortex? To which artery would such a lesion apply?

Answer 27

Contralateral hemianopia with macular sparing

Question 28

What major 7 areas of the brain are in the basilar artery territory?

Answer 28

(1) Pons (2) Medulla (3) Lower midbrain (4) Corticospinal and (5) Corticobulbar tracts (6) Ocular cranial nerve nuclei (7) Paramedian pontine reticular formation

Question 29

Again, what 7 areas of the brain are in the basilar artery territory? What symptoms are caused by a basilar artery lesion? What is the collective name for these symptoms?

Answer 29

Pons, medullar, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, paremedian pontine reticular formation; Preserved consciousness and blinking, quadriplegia, loss of voluntary facial, mouth, and tongue movements; “Locked-in syndrome”

Question 30

What are the 2 communicating arteries? What kind of lesions are typically seen in these arteries?

Answer 30

(1) ACom (anterior communicating) (2) PCom (posterior communicating); Lesions are typically aneurysms, not strokes

Question 31

What is the most common lesion in ACom? What are 2 complications associated with this lesion?

Answer 31

Most common lesion is aneurysm; (1) Can lead to stroke (2) Saccular (berry) aneurysm can impinge cranial nerves

Question 32

What symptom(s) is (are) associated with an ACom lesion?

Answer 32

Visual field defects

Question 33

What lesion is common in PCom?

Answer 33

Common site of saccular aneurysm

Question 34

What symptom(s) is (are) associated with a PCom lesion?

Answer 34

CN III palsy - eye is “down and out” with ptosis and pupil dilation

Question 35

In general, what is an aneurysm, and what causes it?

Answer 35

In general, an abnormal dilation of artery due to weakening of vessel wall

Question 36

Where does a Berry aneurysm occur?

Answer 36

Occurs at the bifurcations in the circle of Willis

Question 37

What is the most common site of a Berry aneurysm?

Answer 37

Most common site is junction of the anterior communicating artery and anterior cerebral artery

Question 38

What is the most common complication of a Berry aneurysm? What are 2 consequences that such a complication may have?

Answer 38

Rupture (most common complication) leads to subarachnoid hemorrhage (“worst headache of life”) or hemorrhagic stroke

Question 39

Besides rupture, what is another complication that may result from a Berry aneurysm, and what causes it?

Answer 39

Can also cause bitemporal hemianopia via compression of optic chiasm

Question 40

What 3 diseases/conditions associated with Berry aneurysms?

Answer 40

Associated with ADPKD, Ehlers-Danlos syndrome, and Marfan syndrome

Question 41

What are 4 risk factors associated with Berry aneurysms?

Answer 41

Other risk factors: advanced age, hypertension, smoking, race (increased risk in blacks)

Question 42

With what condition is Charcot-Bouchard microaneurysm associated?

Answer 42

Associated with chronic hypertension

Question 43

In general, what structures in the brain does Charcot-Bouchard microaneurysm affect? Give 2 specific examples.

Answer 43

Affects small vessels (e.g., in basal ganglia, thalamus)

Question 44

What is Central post-stroke pain syndrome, and what causes it?

Answer 44

Neuropathic pain due to thalamic lesions

Question 45

What are the initial versus later symptoms of Central post-stroke pain syndrome, and what time frame typically separates them?

Answer 45

Initial sensation of numbness and tingling followed in weeks to months by allodynia (ordinary painless stimuli cause pain) and dysaesthesia.

Question 46

In what percentage of stroke patients does Central post-stroke pain syndrome occur?

Answer 46

Occurs in 10% of stroke patients