Stroke Flashcards
features of ica syndrome
- most variable stroke syndrome
- can cause infarction of 2/3 of the cerebral hemisphere
- infarction can be bilateral (if from common ica)
combination of aca, acha, and mca syndrome
signs and symptoms for ica syndrome
transient monocular blindness (amaurosis fugax) contralateral motor and sensory deficits in face, UE, and LE contralateral visual field deficit (homonymous hemianopia) aphasia (dom) perceptual deficits (nondom)
branches of the aca
acomm recurrent artery of heubner medial orbitofrontal artery frontopolar artery callosomarginal artery pericallosal artery
manifestations of lesions in recurrent artery of heubner
contralateral face and arm weakness without sensory loss
behavioral and cognitive abnormalities (abulia, agitation, neglect, and aphasia)
manifestations of aca infarct
weakness of the leg
+/- proximal muscle weakness in the UE
frontal lobe: judgment, insight, affect, abulia
frontal release signs: grasp and suck reflex
urinary incontinence
segments of mca
sphenoidal
insular
opercular
cortical
superior portions of mca
lateral Orbitofrontal a.
Prerolandic a. (motor)
Rolandic a. (motor and sensory)
Anterior parietal a.
inferior portions of mca
Posterior parietal
Angular gyrus
temporo-occipital, Posterior temporal
Anterior temporal
manifestations of mca non-dominant infarct
left hemiparesis left sensory loss left homonymous hemianopia contralateral conjugate paralysis dysarthria left hemineglect anosognosia constructional apraxia, topographagnosia, dressing apraxia
manifestations of mca dominant infarct
right motor loss of face and UE/LE
right sensory loss: all modalities, decreased stereognosis, graphesthesia
right homonymous hemianopia
dysarthria
aphasia, alexia, agraphia, acalculia, apraxia of left limbs
manifestations of superior division infarct
contralateral hemiplegia, hemisensory loss, hemianopia, gaze paresis
global aphasia/dysphasia or anosognosia and hemineglect
gerstmann syndrome
manifestations of inferior division infarct
hemianopia
wernicke’s aphasia/dysphasia or anosognosia
hemineglect
anterior spinal artery supplies
medullary pyramids
paramedian medullary structures
anterior 2/3 of spinal cord
pica supplies
inferior surface of cerebellum
dorsolateral surface of medulla oblongata
choroid plexus of 4th ventricle
deep cerebellar nuclei
posterior spinal artery supplies
posterior aspect of medulla below obex
posterior column and posterior horns of spinal cord
long circumferential arteries
anterior inferior cerebellar a.
auditory a.
superior cerebellar a.
anterior inferior cerebellar a. supplies
inferior surface of cerebellum
brachium pontis (middle peduncle)
restiform body (inf. peduncle)
tegmentum of lower pons and upper medulla
auditory a. supplies
inner ear and root fibers of facial nerve
superior cerebellar a. supplies
superior of cerebellum part of dentate nucleus brachium pontis and conjunctivum tegmentum of upper pons inferior colliculus
short circumferential a. supplies
pons
symptoms of vertebro-basilar stroke
- motor: contralateral paresis of UE/LE, peripheral facial palsy
- dysarthria, hoarseness, dysphagia, ipsilateral ataxia
- cerebellar signs
- disconjugate eye movements
manifestations of stroke in pons
locked in syndrome
facial and limb paralysis
(loss of cst + sparing of vertical gaze and consciousness)
pca supplies
medial of occipital lobe
temporal lobe
caudal parietal lobe
splenium of corpus callosum
manifestations of pca infarct in cortical a.
homonymous hemianopsia, cortical blindness, severe visual deficits, visual hallucinations, impaired memory
manifestations of pca infarct in penetrating a.
thalamus: contralateral sensory loss
brainstem: CN palsies, nystagmus, pupillary abnormalities
_____ and ___ are damaged in parinaud’s syndrome
DORSAL MIDBRAIN
superior colliculus and midbrain tectum
____ generates upward gaze
___ maintains upward gaze
rostral interstitial nucleus of medial LF (rimlf) = generates
interstitial nucleus of cajal (inc) = maintains
manifestations of lesion in posterior comissure
damaged pupillary constriction = large pupils
findings in parinaud’s syndrome
upward gaze paralysis
normal to large pupils with light near dissociation
lid retraction
convergence-retraction nystagmus
common causes of parinaud’s syndrome
pineal gland tumors
thalamic/midbrain hemorrhage
infarction
trauma
what is damaged in weber syndrome
fascicle of cn 3
corticospinal tract
corticobulbar tract
findings in weber syndrome
ipsilateral oculomotor paresis
ptosis
dilated pupils
contralateral hemiplegia including lower face
common cause of weber syndrome
occlusion of median and paramedian perforating arteries of midbrain
what is damaged in claude syndrome
fascicle of cn 3
dentatothalamic projections
findings in claude syndrome
ipsilateral oculomotor paresis
ptosis
dilated pupil
contralateral cerebellar dysfunction
what is damaged in benedikt syndrome
fascicle of cn 3 red nucleus corticospinal tract medial lemniscal tract spinothalamic tract
findings in benedikt syndrome
ipsilateral oculomotor paresis
ptosis
dilated pupil
contralateral involuntary movements (intention tremor, ataxia, chorea)
contralateral hemiparesis and hemianesthesia
what is damaged in nothnagel syndrome
TECTUM
cn 3
rimlf
dentatothalamic projections
findings in nothnagel syndrome
ipsilateral oculomotor palsy
contralateral upward gaze palsy
ipsilateral or contralateral ataxia
what is damaged in locked in syndrome
cst in ventral pons
corticobulbar tracts
nuclei and fibers of cn 6
findings in locked in syndrome
quadriplegia preserved consciousness unable to speak cannot move face limited horizontal eye movement
what is damaged in raymond cestan syndrome
sup and mid cerebellaar peduncles
sensory and motor cn 5
spinothalamic tract and medial lemniscus
cst
findings in raymond cestan syndrome
ipsilateral ataxia and coarse intentioni termor
ipsilateral paralysis of musclesof mastication
facial sensory loss
contralateral hemianesthesia
cotnralateral hemiparesis of face and body
ipsi hori gaze palsy
what is damaged in foville syndrome
nucleus and fibers of cn 7
pprf
cst
findings in foville syndrome
ipsi paresis of whole face
ipsi hori gaze palsy
contra hemiplegia and hemianes
what is damaged in millard gubler syndrome
cn 6 and 7
cst
findings in millard gubler syndrome
ipsi paresis or LR
ipsi paresis of upper and lower face
contralateral hemiplegia
what is damaged in wallenberg syndrome
descending cn 5 cn 9 and 10 descending sympathetic fibers inf cerebellar peduncle spinothalamic tract vestibbular nuclei
findings in wallenberg syndrome
ipsi loss of pain and temp sensation in face
ipsi paralysis of palate, pharynx, and vocal cords
ipsi horner’s syndrome
ipsi ataxia and dysmetria
contra hemianes
vertigo, nausea, vomiting, nystagmus
what is damages in dejerine syndrome
cn 12, cst, medial lemniscus
findings in dejerine syndrome
ipsi paresis of tongue
contralateral hemiplegia
contra loss of position and vibratory sensation
