Stroke

Question 1

Total anterior circulation infarcts (TACI)

Answer 1

HHH
Hemisensory loess/hemiparesis
Homonymous hemianopia
Higher cognitive dysfunction e.g. dysphasia

Question 2

Partial anterior circulation infarcts

Answer 2

Involves smaller arteries of the anterior circulation e.g. upper or lower division of middle cerebral artery
Higher cognitive dysfunction or 2 out of 3 TACI features

Question 3

Lacunar infarcts

Answer 3

Involves perforating arteries around the internal capsule, thalamus and basal ganglia

Presents with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

Question 4

Posterior circulation infarcts

Answer 4

Vertebrobasilar infarcts
Presents with features of brainstem damage
Ataxia, disorders of gaze and vision, cranial nerve lesions

Question 5

Lateral medullary syndrome (posterior inferior cerebellar artery)

Answer 5

Wallenberg’s syndrome

This syndrome is characterised by:

vestibulocerebellar symptoms: vertigo, falling towards the side of lesion, diplopia, and multidirectional nystagmus (inferior cerebellar peduncle and vestibular nucleus)
autonomic dysfunction: ipsilateral Horner’s syndrome, hiccups
sensory symptoms: initially abnormal stabbing pain over the ipsilateral face then loss of pain and temperature sensation over the contralateral side of body (spinal trigeminal nucleus involvement)
ipsilateral bulbar muscle weakness: hoarseness, dysphonia, dysphagia, and dysarthria, decreased gag reflex (nucleus ambiguus)

Ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s

Contralateral: limb sensory loss

Question 6

Weber’s syndrome

Answer 6

Ipsilateral III palsy

Contralateral weakness

Question 7

Pontine

Answer 7

Pontine syndromes normally manifest as a gaze palsy TOWARDS the side of the lesion
Ipsialteral abducens and facial palsies may be present as well as contralateral hemiplegia

VI nerve: horizontal gaze palsy
VII nerve
Contralateral hemiparesis

Question 8

Posterior cerebral artery

Answer 8

Contralateral hemianopia with macular sparing

Question 9

Middle cerebral artery

Answer 9

Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral hemianopia
Aphasia (Wernicke’s)
Gaze abnormalities