Stroke Flashcards by CABS Cabanela

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

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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)

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branches of the aca

acomm
recurrent artery of heubner
medial orbitofrontal artery
frontopolar artery
callosomarginal artery
pericallosal artery

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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)

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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

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segments of mca

sphenoidal
insular
opercular
cortical

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superior portions of mca

lateral Orbitofrontal a.
Prerolandic a. (motor)
Rolandic a. (motor and sensory)
Anterior parietal a.

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inferior portions of mca

Posterior parietal
Angular gyrus
temporo-occipital, Posterior temporal
Anterior temporal

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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

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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

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manifestations of superior division infarct

contralateral hemiplegia, hemisensory loss, hemianopia, gaze paresis
global aphasia/dysphasia or anosognosia and hemineglect
gerstmann syndrome

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manifestations of inferior division infarct

hemianopia
wernicke’s aphasia/dysphasia or anosognosia
hemineglect

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anterior spinal artery supplies

medullary pyramids
paramedian medullary structures
anterior 2/3 of spinal cord

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pica supplies

inferior surface of cerebellum
dorsolateral surface of medulla oblongata
choroid plexus of 4th ventricle
deep cerebellar nuclei

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posterior spinal artery supplies

posterior aspect of medulla below obex

posterior column and posterior horns of spinal cord

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long circumferential arteries

anterior inferior cerebellar a.
auditory a.
superior cerebellar a.

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anterior inferior cerebellar a. supplies

inferior surface of cerebellum
brachium pontis (middle peduncle)
restiform body (inf. peduncle)
tegmentum of lower pons and upper medulla

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auditory a. supplies

inner ear and root fibers of facial nerve

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superior cerebellar a. supplies

superior of cerebellum
part of dentate nucleus
brachium pontis and conjunctivum
tegmentum of upper pons
inferior colliculus

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short circumferential a. supplies

pons

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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