Strokes

Question 1

Anterior Cerebral Artery

Answer 1

Motor Cortex: lower limb-contralateral paralysis

Sensory Cortex: lower limb-contralateral loss of sensation of lower limb

Question 2

Lenticulostriate artery

Answer 2

In striatum, internal capsule (basal ganglia, thalamus, pons)

May not show up on Initial CT!!!!

Soft and edamatous brain soon after injury
Weeks there is a cystic space surrounded by scar tissue (now shows up on CT)-lacunar
Due to lipohyalniosis: loss arterial architecture with mural foam cells and acutely fibrinoid necrosis
or microateheromas: Lipid laden macrophages in intimal layer that cause occlusion of penetrating arteries

Symptoms: contralateral hemiparesis/hemiplegia

Pure motor: internal capsule or basal pons
Pure sensory: VPL or VPM
Ataxia/hemiplegia: posterior limb of internal capsule
Dysarthia/clumsy hand: genu of internal capsule

Diabetes and smoking are risk factors (hypertension)

Question 3

Anterior Spinal Artery

Answer 3

Lateral corticospinal tract: contralateral hemiparesis of upper and lower limbs (Spares Lissauer tract and dorsal columns)

Medial lemniscus: decreased contralateral proprioception

Caudal medulla-hypoglossal artery-ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)

Stroke commonly bilateral

Question 4

Posterior inferior cerebellar aretery

Answer 4

Lateral medulla-vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguus, sympathetic fibers, inferior cerebellar peduncle

Symptoms: vomiting, vertigo, nystagmus
Decreased pain and temperature sensation from ipsilateral face and cotnralateral body
Dysphagia, hoarseness (nucleus ambiguus)
decreased gag reflex
ipsilateral horner syndrome, ataxia, lack of coordination of movement (dysmetria)

Nucleus ambiggus effects are specific to PICA (do not Pica someone who is ambiguus)

Question 5

Anterior Inferior Cerebellar artery

Answer 5

Lateral pons: CN nuclei,
Vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers

Symptoms: vomiting, vertigo, nystagmus
paralysis of face, decreased lacrimation, salivation, decreased taste from anterior 2/3 of tongue
Decreased corneal reflex

face-decreased pain and temp, sensation
Ipsilateral decreased hearing
Ipsilateral horner syndrome

Middle and inferior cerebellar peduncles-ataxia and dysmetria

Facial nucleus effects are specific to AICA

Question 6

Middle Cerebral Artery

Answer 6

Motor cortex: upper limb and face-contalateral paralysis

Sensory cortex: upper limb and face-contralateral loss of sensation-upper and lower limbs, and face

Temporal lobe: Werenicke area
Frontal lobe: broca Area
Aphasia if dominant (usually left)
Hemineglect of contralateral side if not dominant

Question 7

PCA

Answer 7

Occipital cortex, visual cortex

Contralateral hemianopia with macular sparing

Supplies CN III and IV, thalamus, medial temporal, splenium, parahippocampal and fusiform gyrus and occipital lobe

Question 8

Basilar artery

Answer 8

Pons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular CN nuclei, paramedian pontine reticular formation

Symptoms: perserved consciousness and blinking
Quadriplegia, loss of voluntary facial mouth and tongue movements

“locked in syndrome”

Question 9

ACom

Answer 9

Most common lesion is aneurysm-can impinge cranial nerves

Visual field defects

Question 10

PCom

Answer 10

Common site of saccuar aneurysm

CNIII palsy-down and out with ptosis and pupil dilation