Stroke

Question 1

Describe the possible consequences of an anterior cerebral artery infarct

Answer 1

Contralateral lower limb weakness and sensory deficit
Urinary incontinence
Split brain syndrome/ alien hand syndrome (corpus callosum)
Frontal lobe features

Question 2

Describe the possible consequences of a proximal middle cerebral artery infarct

Answer 2

Full contralateral hemiparesis
Contralateral sensory loss in upper limb and face
Contralateral homonymous hemianopia
Dense aphasia (Broca’s and Wernicke’s aphasia)
Contralateral hemispatial neglect (Right parietal lobe affected)

Question 3

Describe the possible consequences of an occlusion in the superior division of the middle cerebral artery

Answer 3

Contralateral face and arm weakness

Broca’s aphasia/expressive aphasia

Question 4

Describe the possible consequences of an occlusion in the inferior division of the middle cerebral artery

Answer 4

Contralateral sensory deficit in upper body and face
Wernicke’s aphasia/ fluent aphasia
Homonymous hemianopia or quadrantanopia -not macular sparing

Question 5

Describe the possible consequences of an occlusion in the PCA

Answer 5

Contralateral homonymous hemianopia- macula sparing (MCA supply)
Contralateral sensory loss (due to thalamic involvement)

Question 6

Describe the possible consequences of an occlusion in the cerebellar artery

Answer 6

Ipsilateral cerebellar deficits- DANISH
-Dysdiadochokinesis
-Ataxia
-Nystagmus
-Intention tremor
-Slurred speech 
-Hypotonia 
Ipsilateral horner’s syndrome
Contralateral sensory signs

Question 7

Describe the possible consequences of an occlusion in the basilar artery

Answer 7

Visual and oculomotor defect

Locked in syndrome/complete bilateral motor loss- spares oculomotor nerve

Question 8

Briefly describe the Oxford classification ‘TACS’

Answer 8

All 3:
Unilateral weakness
Homonymous hemianopia
Higher cerebral dysfunction- dysphasia, visuospatial disorder

Question 9

Briefly describe the Oxford classification ‘PACS’

Answer 9

2 of:
Unilateral weakness
Homonymous hemianopia
Higher cerebral dysfunction- dysphasia, visuospatial disorder

Question 10

Briefly describe the Oxford classification ‘POCS’

Answer 10

1 of:
Cranial nerve palsy + contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movement disorder
Cerebellar dysfunction
Isolated homonymous hemianopia (macular sparing)

Question 11

Briefly describe the Oxford classification ‘LACS’

Answer 11

1 of: 
Pure sensory deficit
Pure motor deficit
Sensory-motor deficit 
Ataxic hemiparesis

Question 12

Briefly describe the main signs of brainstem pathology

Answer 12

Ipsilateral CN signs

Contralateral sensory and motor tract deficits