Phys: Cerebral Blood Supply and Clinical Correlation Flashcards
What surfaces of brain will ACA perfuse?
Anterior and medial surface
What lobes of brain will ACA perfuse?
Frontal (cognitive) to anterior parietal (sensory center)
ACA will perfuse what structure that connects the two hemispheres?
Corpus Callosum
2/3 of strokes happen in which artery?
MCA
The superior MCA perfuses what lobes?
Lateral/inferior frontal lobe (cognitive)
Anterior/lateral parietal lobe (sensory)
The inferior MCA perfuses what lobes?
Lateral temporal lobe (auditory and memory)
Lateral occipital lobe (vision)
Choose Left MCA/Right MCA or both:
Aphasia (loss of ability to produce/understand speech)
Only left MCA
Language intact in Right MCA
Choose Left MCA/Right MCA or both:
Dysarthria (difficulty swallowing)
Both
Choose Left MCA/Right MCA or both:
Hemiparesis (sensory loss)
Both
R in a left MCA
L in a right mca
Choose Left MCA/Right MCA or both:
Visual field defect
Left MCA
Will have neglect of L visual field/L visual field cut in a Right MCA
Choose Left MCA/Right MCA or both:
Poor conjugate gaze
Both
R in a left MCA
L in a Right MCA
Choose Left MCA/Right MCA or both:
Spatial disorientation
Right MCA
Difficult reading, writing, calculating in a Left MCA
Choose Left MCA/Right MCA or both:
Apraxia (inability to complete already learned tasks on command)
Left MCA
flat affect in a Right MCA
Choose Left MCA/Right MCA or both:
Impulsive
Right MCA
Cautious with a Left MCA
What are the small perforating arteries that branch off the MCA and supply the basal ganglia (movement generation) and the internal capsule (corticospinal tract)?
Lenticulostriate Arteries
When the lenticulostriate arteries are blocked what is it called?
What is it referred to when internal capsule involved?
What deficits when basal ganglia involved?
- Lacunar infarct
- Referred to as “pure motor hemiparesis” when internal capsule involved
- Motor control and motor planning deficits when basal ganglia involved
What structures does the PCA supply?
Occipital lobe, poteromedial temporal lobes, thalamus
If your sign/symptom is central post-stroke pain, what structures are involved?
Thalamus
If your sign/symptom is involuntary movements, what structure are involved?
Choreoasthetosis - face/trunk/extremities
Intention tremor - shake when try and do something
Hemiballismus - big circular movements
Subthalamus
When a vertebrobasilar artery syndrome occurs, you see locked-in syndrome. What is that?
What symptoms?
What stays in tact?
Can’t move anything but their eyes
-Basilar artery thrombosis and bilateral infarction of ventral pons
-Acute hemiparesis, anarthria
What stays intact?
-Preserved consciousness and sensation
-Vertical eye movements and blink remain intact
Mortality = 59%
Patient has an ACA, they will experience hemiparesis (mild weakness) or hemiplegia (severe weakness) due to what structure involved?
Ipsilateral/contralateral?
LE/UE?
medial aspect of Motor cortex
Contralateral
LE>UE
Patient has an ACA, they will experience hemisensory loos due to what structure involved?
Ipsilateral/contralateral?
LE/UE?
Medial aspect of sensory cortex
Contralateral
LE>UE
Patient has an ACA, they will experience apraxia. What is apraxia? What structures (2) are involved?
Apraxia - inability to complete already learned tasks on command
Supplementary motor area (integration) and corpus callosum
Due to corpus callosum involvement in an ACA, what type of task will patient have difficulty with?
Bimanual tasks
Due to frontal cortex involvement in an ACA, what type deficits will the patient present with?
Significant cognitive deficits (agitation, memory, emotional liability, motor preservation)
Due to prefrontal cortex involvement in an ACA, what type of task will patient have difficulty with?
Lack of spontaneity, motor inaction, slowness and delay, difficulties with executive function tasks (attention)
What type of aphasia will a patient with an ACA present with due to involvement of the supplementary motor area?
Transcorticol aphasia (loss of ability to produce/understand speech)
T/F, a patient with an ACA will present with contralateral grasp reflex/sucking reflex
T: due to corpus callosum or frontal lobe?
What additional syndrome will a patient with ACA involvement of the supplementary motor area present with?
Alien hand syndrome - randomly do things w/o patient’s knowledge
Due to posteromedial aspect of superior frontal gyrus involvement in an ACA, what sign will a patient present with?
Urinary incontinence
ACA treatment strategies (4):
- Minimize external distractions
- Closed chain, big muscle exercises (squats, steps)
- Bimanual activities (tackle UE deficits)
- Function-based training (WALK)
Patient has an MCA, they will experience paresis due to what structure involved?
Ipsilateral/contralateral?
LE/UE?
Motor cortex and internal capsule
- Contralateral
- UE and face>LE
Patient has an MCA, they will experience sensory loss due to what structure involved?
Ipsilateral/contralateral?
LE/UE?
sensory cortex and internal capsule
- Contralateral
- UE and face>LE
Patient has an MCA, they will experience:
motor speech impairment -
receptive speech impairment -
global aphasia -
…due to involvement of what structures?
motor speech impairment - Broca’s (dominant hemi)
receptive speech impairment - Wernicke’s (dom)
global aphasia - Both broca’s and wernicke’s
Patient has an MCA, they will experience perceptual deficits if the parietal sensory association cortex of the non dominant hemisphere is involved? What are the signs and symptoms?
Perceptual deficits - unilateral neglect (unable to perceive entire left side of vision), depth perception, spatial relations
With an MCA in a patient, they will experience apraxia (inability to complete already learned tasks on command) just like a patient with an ACA would. However, the structure involved is different.
What is the structure in a MCA? (could be two)
Premotor or parietal cortex
Patient has an MCA, they will experience visual deficits due to what structure involvement?
Optic radiation in internal capsule
Patient has an MCA, due to the frontal eye field or descending tract involvement, what sign will the patient present with?
Loss of conjugate gaze
A lacunar stroke is possible with MCA involvement. What sign/symptom will patient present with?
What structure of brain?
Pure motor hemiplegia
Lenticulostriate arteries that branch off the MCA found in internal capsule
MCA treatment strategies (3)
- Incorporate speech strategies into activities
- UE functional training (Closed kinetic chain)
- Sensory reintegration is key
Patient has a PCA and is experiencing homonymous hemianopsia.
What is that?
What structures (2) are involved?
homonymous hemianopsia - lose same side of vision in both eyes
- Visual cortex or optic radiation
Patient has a PCA involving their bilateral occipital lobe. What signs and symptoms will they experience?
Cortical blindness - blindness on both sides
Patient has a PCA and is experiencing visual agnosia.
What is that?
What structure is involved? (Dom or Nondom?)
Visual Agnosia - lose ability to recognize familiar things/people/voices (auditory agnosia)
- Occipital lobe (dom side)
Patient has a PCA and is experiencing prosopagnosia.
What is that?
What structure is involved?
prosopagnosia - unable to associate faces
- Visual association cortex
Patient has a PCA involving their dominant calcarine lesion and the posterior part of their corpus callosum.
What signs and symptoms will they experience?
Dyslexia
Patient has a PCA involving their dominant inferomedial portions of the temporal lobe.
What signs and symptoms will they experience?
Memory deficits
Patient has a PCA and is experiencing topographic disorientation.
What is that?
What structure is involved?
topographic disorientation - difficulty reading map, familiar location cues to find their way)
- Non dominant visual area
PCA treatment strategies (4):
- Gradually increase visual challenges
- Visual deficits can significantly impact balance
- Visual breaks
- May require external aids initially to assist in improving visual deficits
