Neuro4 Stroke Lesions

Question 1

MCA

Answer 1

Area of lesion:
Motor cortex-upper limb and face.
Sensory cortex-upper limb and face.
Wernicke’s area, Broca’s area.

Symptoms:
Contralateral paralysis-upper
limb and face.
Contralateral loss of sensationupper
limb and face.
Hemineglect if lesion affects
nondominant (usually right) side.

Question 2

ACA

Answer 2

Motor cortex-lower limb.
Sensory cortex-lower limb.

Contralateral paralysis -lower
limb.
Contralateral loss of sensationlower
limb.

Question 3

Lateral striate artery

Answer 3

Striatum, internal capsule.

Contralateral hemiparesis/
hemiplegia.

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

Question 4

ASA

Answer 4

Lateral corticospinal tract.
Medial lemniscus.
Caudal medulla-hypoglossal nerve.

Contralateral hemiparesis -lower
limbs.
Decreases contralateral proprioception.
Ipsilateral hypoglossal dysfunction
(tongue deviates ipsilaterally) .

Question 5

PICA

Answer 5

Lateral medulla-vestibular nuclei,
lateral spinothalamic tract, spinal
trigeminal nucleus, nucleus
ambiguus, sympathetic fibers.
Inferior cerebellar peduncle.

Vomiting, vertigo, nystagmus.
Limbs/face- Decreased pain, temperature
sensation.
Dysphagia, hoarseness, Decreased gag
reflex.
Ipsilateral Horner's syndrome.
Ataxia, dysmetria.

Lateral medullary
(Wallenberg's) syndrome.
Nucleus ambiguus effects are
specific to PICA lesions.
Don't pick a (PICA) horse
(hoarseness) that can't eat
(dysphagia) .

Question 6

AICA

Answer 6

Lateral pons-vestibular nuclei, facial
nucleus, spinal trigeminal nucleus,
cochlear nuclei, sympathetic fibers.
Middle and inferior cerebellar
peduncles.

Vomiting, vertigo, nystagmus.
Paralysis of face, decreased lacrimation,
salivation, decreased taste from anterior
2/3 of tongue, decreased corneal reflex.
Face- decreased pain and temperature
sensation. Ipsilateral decreased hearing.
Ipsilateral Horner’s syndrome.

Lateral pontine syndrome.
Facial nucleus effects are
specific to AICA lesions.
Facial droop means AICA's
pooped.

Question 7

PCA

Answer 7

Occipital cortex, visual cortex

Contralateral hemianopsia with
macular sparing.

Question 8

AComm

Answer 8

Common site of saccular (berry)
aneurysm: impingement on
cranial nerves.

Visual field defects.

Lesions are typically
aneurysms, not strokes.

Question 9

PComm

Answer 9

Common site of saccular (berry) aneurysm

CN III palsy-eye is “down and out.”

Lesions are typically aneurysms, not strokes.

Question 10

Aneurysms

Answer 10

Berry aneurysms-occur at the bifurcations in
the circle of Willis. Most common site is
bifurcation of the anterior communicating
artery. Rupture (most common complication)
leads to hemorrhagic stroke/subarachnoid
hemorrhage. Associated with ADPKD, EhlersDanlos
syndrome, and Marfan’s syndrome.
Other risk factors : advanced age, hypertension,
smoking, race (higher risk in blacks).
Charcot-Bouchard microaneurysms-associated
with chronic hypertension; affects small vessels
(e.g., in basal ganglia, thalamus) .