Stroke and vascular neurology

Question 1

Ataxic hemiparesis

Answer 1

Posterior limb of internal capsule - MCA penetrating arteries (lenticulostriate) or

Basis pontis - Basillar penetrating arteries

Contralateral ataxia and weakness upper and lower limb

Question 2

Gerstmann’s syndrome

Answer 2

Dominant parietal lobe lesion

Right left confusion

Finger agnosia

Agraphia

Acalculia

Question 3

Inferior branch of the middle cerebral artery

Answer 3

Contralateral homonymous hemianopia or Upper quadrant anopsia

Contralateral receptive aphasia

Contralateral constructive apraxia

Question 4

Middle cerebral artery - superior division

Answer 4

Superior parietal lobe, lateral frontal lobe

Contralateral weakness face, arm >leg

Contralateral sensory loss of face, arm >leg

Contralateral lower quandrantanopia

Contralateral expressive dysphasia (Dominant)

Contralatearl hemineglect (non-dominant)

Question 5

Alexia without agraphia

Answer 5

Pure word blindness (can write but not read)

Collosal branches of posterior cerebral artery

Alexia (splenum of corpus callosum)

Contralateral homonymous hemianopia

Question 6

Balint Syndrome

Answer 6

Bilateral posterior cerebral artery (bilateral parietal occipital lobes)

Optic ataxia

Loss of voluntary eye movements

Asimultagnosia - inability to understand visual objects

Question 7

Claude syndrome

Answer 7

Midbrain tegmentum lesion

Contralateral ataxia of arm and leg

Ipsilateral occulomotor palsy

+/- Contralateral hemiparesis of face and arm

no rubral tremor like benedikt syndrome

Question 8

Benedikt’s syndrome (paramedian midbrain syndrome)

Answer 8

Ipsilateral CNIII lesion

Contralateral hemiataxia upper and lower limb

Rubral tremor

Question 9

Weber syndrome

Answer 9

Contralateral upper and lower limb weakness

Ipsilateral CNIII

Question 10

Anton Syndrome

Answer 10

Cortical blindness and unawareness

Bilateral PCA or top of basilar

Question 11

Posterior artery- unilateral

Answer 11

Contralateral hemianopia only

Question 12

Dejerine-Roussy syndrome

Answer 12

Posterior cerebral artery penetrating thalamus

Contralateral sensory loss face, arm leg

Contralateral pain face arm leg

Question 13

Lateral pontine syndrome (Marie-Foix syndrome)

Answer 13

Anterior inferior cerebellar artery OR

Long penetrating branches of basillar

Ipsilateral ataxia

Contralateral hemiparesis

Contralateral loss of pain and temperature only

Question 14

Lateral medullary syndrome (Wallenburg syndrome)

Answer 14

Posterior inferior cerebellar syndrome

Contralateral loss of pain and temperature -arm and leg

Ipsilateral loss of pain and temp - face (+/- pain)

Ipsilateral Horner’s syndrome

Ipsilateral ataxia

Ipsilateral nystagmus and vertigo

Nausea vomiting and severe dysphagia

Hiccups

Question 15

Inferior median pontine syndrome (Foville syndrome)

Answer 15

Basillar artery - paramedian branches

Contralateral weakness arm and leg

Ipsilateral weakness of face

Ipsilateral gaze palsy (paramedian pontine reticular formation or CNVI nucleus)

Question 16

Locked in syndrome

Answer 16

Bilateral ventral pontine syndrome - basilar artery

Quadriplegia

Bilateral facial weakness

Bilateral gaze weakness

Dysarthria

Patient fully awake, sensation fully spared

Question 17

Medial medullary syndrome (Dejerine syndrome)

Answer 17

Anterior spinal artery

Ipsilateral CNXII lesion (tongue toward lesion)

Contralateral weakness arm and leg

Contralateral loss of vibration and prioception (medial lemniscus)

Question 18

Raymond syndrome

Answer 18

Ventral median pontine syndrome - paramedian arteries of basillar

Ipsilateral CNVI lesion - lateral gaze weakess

Contralateral upper and lower limb weakness

Question 19

Millard-Gubler syndrome

Answer 19

Basis pontis - paramedian branches of basillar

Ipsilateral CNVI lesion - lateral gaze palsy

Ipsilateral facial weakness

Contralateral arm and leg weakness

Question 20

Three nuclei of CNIII

Answer 20

Superior rectus subnucleus - innervates the contralateral superior rectus

Levator subnucleus - bilateral levator palpebrae Ipsi>contra

Edinger-Westfall nucleus- pupillary constriction ipsilaterally

Question 21

Differentials for CNIII palsies

Answer 21

PCOM/ICA/PCA aneurysm - dilated pupil, headache

Infiltration/thrombus in cavernous sinus - CNVI, CNIV, CNIII with smaller pupil, CNV1 numbness

Ischaemic nerve (diabetes) - ptosis, occulomotor palsy, pupillary sparing

Midbrain lesion - Weber, Claude or Benedikt syndrome

Trauma

Opthalmoplegic migraine

Myasthenia, thyroid eye disease