Stroke lesions (passmed)

Question 1

Lesion in anterior cerebral artery effects?

Answer 1

Contralateral hemiparesis and sensory loss.

Mainly affects legs more than arms.

Question 2

Lesions in middle cerebral artery effects?

Answer 2

Contralateral hemiparesis and sensory loss, upper extremity > lower

Contralateral homonymous hemianopia

Aphasia (inability/impaired ability to understand or produce speech).

Question 3

Lesions in posterior cerebral artery effects?

Answer 3

Contralateral homonymous hemianopia with macular sparing

Visual agnosia (impairment in recognising visually presented objects).

Question 4

Weber’s syndrome lesion characteristics?

Answer 4

Ipsilateral (same side) CN 3 palsy.

Contralateral weakness of upper + lower extremity

Question 5

Posterior inferior cerebellar artery lesion characteristics?

Answer 5

Ipsilateral: facial pain and temperature loss.

Contralateral: limb/torso pain + temp loss. Ataxia (loss of full control of body movements) and nystagmus (rapid involuntary movement of eyes).

Question 6

What is the name for the condition where there is a lesion at the posterior inferior cerebellar artery?

Answer 6

Wallenberg syndrome

Question 7

Difference in features between lesion in anterior inferior cerebellar artery and posterior inferior cerebellar artery?

Answer 7

Symptoms are similar to Wallenberg’s (posterior inferior artery lesion).

Contralateral: limb/torso pain + temp loss. Ataxia + nystagmus.
SAME PRESENTATION AS WALLENBERG’S (POSTERIOR INFERIOR CEREBELLAR ARTERY).

Ipsilateral: facial paralysis and deafness. Whereas wallenberg’s is facial pain and temp loss.

Question 8

Retinal/ophthalmic artery lesion characteristics?

Answer 8

Amaurosis fugax

Question 9

Basilar artery lesion characteristics?

Answer 9

‘Locked-in’ syndrome

Question 10

What are the main features of cerebellar dysfunction?

Answer 10

Remember: DANISH

Dysdiadochokinesia (tested by asking patient to make rapid flapping movements by turning hand over)

Ataxia (sensory) - confirmed by Romberg’s test, get patient to stand with eyes closed and see if balance lost.

Nystagmus - get patient to perform eye movements following finger in a “H” shape

Intention tremor - get patient to do finger to nose test.

Slurred speech - get patient to repeat the words “British constitution” and “Baby hippopotamus”

Hypotonia - use tendon hammer and assess for low tone in arms and legs

Question 11

What is dysdiadochokinesia?

Answer 11

Inability to form rapid alternating movements with the hands

Question 12

Location of lesion for Weber’s syndrome?

Answer 12

Branches of the posterior cerebral artery that supply the midbrain

Question 13

What does a lacunar stroke typically present with?

Answer 13

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

Question 14

What is lacunar stroke strongly associated with?

Answer 14

Hypertension

Question 15

What are common sites affected by lacunar stroke?

Answer 15

Basal ganglia, thalamus and internal capsule