Neuro: Stroke Syndromes

Question 1

• Contralateral hemiparesis involving mainly the UE and face
• Contralateral hemisensory loss involving mainly the UE and face
• Wernicke’s Aphasia (fluent) or [receptive]
  
  • Posterior portion of the temporal gyrus (usually left)
• Broca’s Aphasia (non-fluent) or [expressive]
  
  • 3rd Frontal convolution
• May also present with:
  
  • perceptual deficits (e.g., unilateral neglect, anosognosia, apraxia, and spatial disorganization).
  • Contralateral homonymous hemianopsia
  • Loss of conjugate gaze to opposite side

Answer 1

• Middle Cerebral Artery
  
  • Most common syndrome

Question 2

• Contralateral hemiparesis involving mainly the LE (UE is more spared)
• Contralateral hemisensory loss involving mainly the LE (UE is more spared)
• May also present with:
  
  • Urinary incontinence
  • Apraxia and difficulty with imitation of bimanual tasks
  • Akinetic mutism

Answer 2

• Anterior Cerebral Artery

Question 3

• Contralateral Hemiplegia
• Involuntary movements
  
  • Choreathetosis, tremor, hemiballismus
• Homonymous hemianopsia
• Transient contralateral hemiparesis
• May also present with:
  
  • Central post-stroke (thalamic) pain (central territory)
  • Visual agnosia (peripheral territory)
  • Prosopagnosia (difficulty naming people on sight) (peripheral territory)
  • Memory defects (peripheral territory)
  • Dyslexia (peripheral territory)
  • Topographical disorientation (peripheral territory)
  • Weber’s Syndrome: Oculomotor nerve palsy and contralateral hemiplegia
  • Paresis of vertical eye movements, slight miosis and ptosis, and sluggish pupillary light response

Answer 3

• Posterior Cerbral Artery

Question 4

• Caused by small vessel disease deep in the cerebral white matter (penetrating artery disease).
• Strongly associated with hypertensive hemorrhage and diabetic microvascular disease.
• Syndromes are consistent with specific anatomical sites.

Answer 4

• Lacunar Strokes

Question 5

• Lacunar Stroke Syndrome associated with involvement of the posterior limb of the internal capsule, pons, and pyramids.

Answer 5

• Pure Motor Lacunar Stroke

Question 6

• Lacunar Stroke Syndrome associated with involvement of the ventrolateral thalamus or thalamocortical projections.

Answer 6

• Pure Sensory Lacunar Stroke

Question 7

• Ipsilateral paralysis and atrophy of half the tongue with deviation to the paralyzed side when tongue is protruded
• Contralateral paralysis of UE and LE and impaired tactile and proprioceptive sense

Answer 7

• Medial Medullary Syndrome
  
  • Type of Vertebrobasilar Artery Syndrome

Question 8

• Ipsilateral
  
  • decreased pain and temperature sensation in face
  • Ataxia, vertigo, nystagmus (cerebellar symptoms)
  • Sensory impairment of ipsilateral UE, trunk, or LE
  • Horner’s syndrome: miosis, ptosis, decreased sweating
  • Dysphagia and dysphonia: paralysis of palatal and laryngeal muscles, diminished gag reflex
• Contralateral
  
  • Impaired pain and thermal sense over 50% of body, sometimes face

Answer 8

• Lateral medullary syndrome
  
  • Also called Wallenburg’s
  • Type of Vertebrobasilar Artery Syndrome

Question 9

• Tetraplegia (quadriplegia)
• Bilateral cranial nerve palsy: upward gaze is spared
• Coma
• Cognition is spared

Answer 9

• Locked-in syndrome
  
  • Complete basilar artery syndrome
    
    • basilar artery thrombosis and bilateral infarction of the ventral pons.
  • The patient cannot move or speak but remains alert and oriented.
  • Communication can be established via vertical eye movements and blinking

Question 10

• Ipsilateral:
  
  • Paralysis of conjugate gaze to side of lesion (preservation of convergence)
  • Nystagmus
  • Ataxia of limbs and gait
  • Diplopia on lateral gaze
• Contralateral:
  
  • Paresis of face, UE, and LE
  • Impaired tactile and proprioceptive sense over 50% of the body

Answer 10

• Medial Inferior Pontine Syndrome
  
  • Type of Vertebrobasilar artery syndrome
  • Occlusion of paramedian branch of basilar artery

Question 11

• Ipsilateral:
  
  • Horizontal and vertical nystagmus, vertigo, nausea, vomiting
  • Facial paralysis
  • Paralysis of conjugate gaze to side of lesion
  • Deafness, tinnitus
  • Ataxia
  • Impaired sensation over face
• Contralateral:
  
  • Impaired pain and thermal sense over half the body (may include face)

Answer 11

• Lateral inferior pontine syndrome
  
  • Type of Vertebrobasilar Artery Syndrome

Question 12

• Supranuclear palsy:
  
  • affects only the contralateral lower half of the face

Answer 12

• Internal capsule lesion