Stroke Pathology: Vascular Syndromes

Question 1

What area(s) does the middle cerebral artery supply?

Answer 1

Lateral surface of the brain, the basal ganglia and internal capsule

Question 2

What area does the anterior cerebral artery supply?

Answer 2

Much of the medial surface of the brain, a narrow strip of the parasagittal lateral surface

Question 3

What area does the posterior cerebral artery supply?

Answer 3

The medial surface of the occipital lobe, notably the primary visual cortex and visual association cortex on the medial surface, the thalamus

Question 4

Which artery supplies the leg area of the sensory and motor strips?

Answer 4

the anterior cerebral artery

Question 5

Which artery supplies the arm and face area of the sensory and motor strips?

Answer 5

the middle cerebral artery

Question 6

What are the lenticulostriate arteries?

Answer 6

They arise from the middle cerebral stem in the sylvian fissure. they supply the internal capsule which contains tightly packed fibers going to arm, leg and face areas.

Question 7

Where does the middle cerebral artery bifurcate?

Answer 7

In the sylvian fissure into a superior and an inferior division

Question 8

what does the superior division of the mca supply?

Answer 8

the sensory and motor strips, broca’s area, the frontal eye fields, the superior parietal lobules

Question 9

what does the inferior division of the mca supply?

Answer 9

wenicke’s area, much of the temporal lobe and the inferior parietal lobule

Question 10

How is the circle of Willis connected?

Answer 10

The posterior cerebral arteries are connected to the middle cerebral arteries by the posterior communicating arteries. One or more anterior communicating arteries connect the anterior cerebral arteries on each side to each other.

Question 11

What are the symptoms of a stroke in the cortical territory of the MCA

Answer 11

There is a hemiparesis that is worse in the face and arm than leg. This is typical of cortical involvement due to vascular disease. Other features of involvement are cotical sensory loss that is worse in the hand, aphasia if the lesion is onthe left, neglect and denial of deficit if lesion is on the right.

Question 12

What is the result of a superior division mca infarct?

Answer 12

Contralateral hemiparesis worse in arm and face than leg, Broca’s aphasia if the lesion is on the left, contralateral hemisensory loss in the same distributionwith features of cortical sensory loss. If lesion is on the right, there is neglect and denial of the deficit.

Question 13

What is the result of an inferior division mca infact?

Answer 13

These do not cause weakness.In left sided lesions there is a sensory (wernicke’s) aphasia. In right sided lesions there are constructional and spatial problems. A visual field deficit results from interruption of optic radiation. This takes the form of a contralateral superior quadrantanopia “pie in the sky” due to interruption of fibers in Meyer’s loop. THese fibers come from the inferior retina.

Question 14

What is the result of capsular lacunes in the mca area?

Answer 14

These are due to small vessel disease. If situated in the region of the corticospinal tract, it produces a dense contralateral hemiparesis involving arm, leg and face equally. There are no language, visual or behavioral abnormalities. “pure motor hemiplegia”

Question 15

What is the result of anterior cerebral infarcts?

Answer 15

It produces contralateral weakness and sensory loss worse in the legs than in the arms.

Question 16

What is the result of posterior cerebral artery infarcts?

Answer 16

Contralateral hemianopia. If the occulsion is before the branches to the thalamus, there wil be a contralateral hemisensory deficit. Bilateral posterio cerebral infarcts result in cortical blindness, sometimes with denial.

Question 17

What is the result of watershed infarcts?

Answer 17

They occur at the areas of overlap between vascular territories. Classic lesions are at th junction of the MCA and ACA. This zone intercepts the sensorimotor strip in teh region o the proximal arm and lef. THere is weakness and sensory loss in these areas “man in the barrel”. Deficit is often bilateral.

Question 18

What is the result of an infarct in the MCA superior?

Answer 18

Weakness=arm and face worse than leg, sensory=arm worse than leg
aphasia (L)=broca’s
other=denial if right sided

Question 19

What is the result of an infarct in the MCA inferior?

Answer 19

aphasia (L)=wernicke’s
visual=superior quadrantanopia
other=construction if right sided

Question 20

What is the result of lancunes?

Answer 20

Weakness=arm, leg, face

Question 21

What is the result of MCA stem infarcts?

Answer 21

weakness=arm, face, leg
sensory=arm, face, leg
aphasia (L)=global
visual =variable
other=parietal syndrome if right sided

Question 22

What is the result of watershed infarct between ACA-MCA?

Answer 22

weakness=proximal arm and proximal leg
sensory=proximal arm and proximal leg
other=often bilateral

Question 23

What is the result of an infarct in the PCA?

Answer 23

sensory=hemibody if thalamus is involved
visual=hemianopia
other=anton’s syndrome (denial of deficit)

Question 24

What kind of aneurysms are found on cerebral vessels?

Answer 24

saccular aneurysms

Question 25

Where are cerebral aneurysms found?

Answer 25

they are found at arterial bifuractions.
most common sites (85%):
-anterior communicating artery,
-the junction of internal carotid and the posterior communicating artery
-junction of the internal carotid and the proximal anterior cerebral artery
-bifurcation of the middle cerebral artery in the sylvian fissure.
only 15% are found in the posterior circulation, most common is bifurcation of basilar artery