Stroke Syndromes and Neurology triads

Question 1

MCA stroke: lobes supplied

Answer 1

Frontal, temporal, parietal

Question 2

Dominant MCA stroke syndrome

Answer 2

Usually L sided stroke: Left, learning, language.
Motor and sensory deficit Face, UL>LL
Aphasia
Apraxia (cannot execute purposeful activity despite strength, mobility, comprehension
Neglect
Eye deviation toward lesion (ipsilateral CN III damage)
Potential hemianopia

Question 3

Gerstmann syndrome

Answer 3

Stroke in the dominant inferior parietal lobe: Dysgraphia, dyscalculia, finger agnosia, left right disorientation
MCA territory

Question 4

Non-dominant MCA stroke

Answer 4

Planning, spacial awareness, initiation
Neglect is common and inability to sense, respond or orientate to sensory stimuli to contralateral side to stroke
Anosognosia (lack of awareness or insight)
Motor, sensory Face UL > LL

Question 5

ACA stroke syndrome

Answer 5

Contralateral lower limb weakness, mutism, incontinence, transcortical motor aphasia (i.e. can repeat, but not initiate), primitive reflexes

Question 6

Defining symptomatology of posterior circulation strokes

Answer 6

Preserved language and cognitive function

Question 7

Midbrain stroke

Answer 7

Contralateral hemiparesis/hemiplegia (corticospinal tract), ipsilateral occulomotor paralysis, 3rd CN affected with dilated pupil, ptosis, lateral gaze preserved

Question 8

Pontine infarct

Answer 8

Ipsilateral hypoglossal nerve (10) palsy, tongue paralysis, dysarthria and dysphagia. Contralateral hemiparesis and decrease in vibration and proprioception (DCML loss), ipsilateral horners.

Question 9

PICA infarct

Answer 9

Supplies the Medulla - lateral wedge aka wallenburgs syndrome (lateral medullary syndrome) PICA or VA stroke
Ipsilateral horners, decrease in pain and temperature to face, cerebellar signs, paralysis of vocal cords

Question 10

Medial Medullary syndrome

Answer 10

Contralateral Weakness – upper and lower extremity from pyramidal tract
Contralateral Hemisensory loss – vibration and proprioceptionMedial lemniscus
Ipsilateral Tongue weakness +/- atrophy Cn 12 nucleus

Question 11

Lateral medullary syndrome

Answer 11

Ipsilateral Sensory loss – face – pain and temperature CN 5 nucleus
Ipsilateral Facial pain CN 5 nucleus
Ipsilateral Ataxia – arm and leg Restiform body, cerebellum
Ipsilateral Gait ataxia Restiform body, cerebellum
Ipsilateral Nystagmus Vestibular nucleus
Ipsilateral Nausea / vomiting Vestibular nucleus
Ipsilateral Vertigo Vestibular nucleus
Ipsilateral Horseness Nucleus ambiguus
Ipsilateral Dysphagia Nucleus ambiguus
Ipsilateral Horner syndrome Descending sympathetics
Contralateral Hemisensory loss – pain and temperature Spinothalamic tract
Hiccups

Question 12

ANATOMY
Cerebral hemisphere: Left occipital region plus splenium of corpus collosum

VASCULAR
Posterior cerebral artery

Answer 12

Pure word blindness. Can write but not read.

Question 13

ANATOMY
Cerebral hemisphere: Posterior limb of external capsule, Pons: Basis pontis

VASCULAR
Middle cerebral artery: Small penetrating arteries
Basilar artery: Small penetrating arteries

Answer 13

Ataxic Hemiparesis

Weakness usually more prominent in leg than arm; extensor plantar response; no facial involvement or dysarthria. Other locations include thalamocapsular lesions, red nucleus, anterior cerebral artery distribution. Also called “homolateral ataxia and crural paresis.”

Question 14

Signs in cerebellar stroke

Answer 14

Ataxia
Dysmetria – past pointing
Dyssenergia – impaired coordination of muscles in single mvmt 
Intention tremor
Dysdiakokinesis 
Nystagmus
Cerebellar/spastic dysarthria