NEURO - Effects of Stroke

Question 1

Middle cerebral artery

MCA

Answer 1

Motor and sensory cortices—upper limb and face.
-Contralateral paralysis and sensory loss—face and upper limb.

Temporal lobe (Wernicke area);
frontal lobe (Broca area).
-Aphasia if in dominant (usually
left) hemisphere. Hemineglect
if lesion affects nondominant
(usually right) side.

Question 2

Anterior cerebral artery

ACA

Answer 2

Motor and sensory cortices—lower limb.

-Contralateral paralysis and sensory loss—lower limb.

Question 3

Lenticulostriate artery

Answer 3

Striatum, internal capsule
-Contralateral paralysis and/or
sensory loss—face and body.
Absence of cortical signs
(eg, neglect, aphasia, visual field loss).

Common location of lacunar
infarcts, 2° to unmanaged
hypertension.

Question 4

Anterior spinal artery

ASA

Answer 4

Lateral corticospinal tract.
-Contralateral paralysis—upper and lower limbs.

Medial lemniscus.
- DEC contralateral proprioception.

Caudal medulla—hypoglossal nerve.
-Ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally).

*Medial medullary syndrome—
caused by infarct of paramedian branches of ASA
and/or vertebral arteries.

Question 5

Posterior inferior cerebellar

artery (PICA)

Answer 5

Lateral medulla
-Vomiting, vertigo, nystagmus;
 pain and temperature sensation from ipsilateral face and contralateral body; *dysphagia, *hoarseness,  gag reflex; ipsilateral Horner syndrome; ataxia, dysmetria.

*Lateral medullary (Wallenberg)
syndrome

*Nucleus ambiguus effects are
specific to PICA lesions.

“Don’t pick a (PICA) horse

(hoarseness) that can’t eat
(dysphagia) .”

Question 6

Anterior inferior cerebellar

artery (AICA)

Answer 6

Lateral pons
-Vomiting, vertigo, nystagmus.
Paralysis of face,  lacrimation,
salivation,  taste from anterior 2⁄3 of tongue.
-Ipsilateral  pain and temperature of the face, contralateral pain and temperature of the body.

Middle and inferior cerebellar
peduncles
-Ataxia, dysmetria

*Lateral pontine syndrome

*Facial nucleus effects are
specific to AICA lesions.

“Facial droop means AICA’s
pooped.”

Question 7

Basilar artery

Answer 7

Pons, medulla, lower midbrain,
corticospinal and corticobulbar
tracts, ocular cranial nerve nuclei, paramedian pontine reticular formation.
-Preserved consciousness, vertical eye movement, blinking; quadriplegia, loss of voluntary facial, mouth, and tongue movements.

*“Locked-in syndrome.”

Question 8

Posterior cerebral artery

PCA

Answer 8

Occipital cortex, visual cortex
-*Contralateral hemianopia with
macular sparing.

Question 9

Anterior communicating artery (Acom)

Answer 9

Compression may cause bitemporal hemianopia; visual acuity deficits.

Rupture (aneurysms) may cause ischemia in ACA distribution–>contralateral lower extremity hemiparesis, sensory deficits.

Question 10

Posterior communicating artery (Pcom)

Answer 10

Compression may cause ipsilateral CN III palsy–>mydriasis (“blown pupil”); may also see ptosis, “down and out” eye.