Strokes - Locate the lesion Flashcards
What kind of lesions tend to affect the communicating arteries?
Aneuryms
Where is the anterior communicating artery?
12:00. Between the two ACAs.
What does anterior communicating artery aneurysm cause?
Visual field defects
Where are the posterior communicating arteries located?
Between posterior cerebral arteries and middle cerebral arteries (5:00 and 7:00).
What does Pcom aneurysm cause?
CN III. Down and out with ptosis and mydriasis.
What areas can be involved in posterior circulation strokes?
posterior inferior cerebellar (PICA), anterior spinal (ASA), anterior infererior cerebellar (AICA), basilar, posterior cerebral.
What areas are affected by anterior spinal artery stroke?
- Lateral corticospinal tract.
- Medial lemniscus.
- Caudal medulla—hypoglossal nerve.
What are the symptoms of anterior spinal artery stroke?
Contralateral hemiparesis—upper and lower limbs. contralateral proprioception. Ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally).
What areas are affected by posterior inferior cerebellar artery stroke?
Lateral medulla—vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguus, sympathetic fibers, inferior cerebellar peduncle.
What are the symptoms of posterior inferior cerebellar artery stroke?
Vomiting, vertigo, nystagmus; decr pain and temperature sensation from ipsilateral face and contralateral body; DYSPHAGIA, HOARSENESS, decr gag reflex; ipsilateral Horner syndrome; ataxia, dysmetria.
What is Wallenburg syndrome?
Laterally medullary stroke - PICA. Nucleus ambiguous is specific to PICA. (Don’t PICA “hoarse” that can’t “eat” – too ambigious!)
What areas are affected by anterior inferior cerebellar artery stroke?
Lateral pons—cranial nerve nuclei;
vestibular nuclei, facial nucleus,
spinal trigeminal nucleus, cochlear
nuclei, sympathetic fibers.
Middle and inferior cerebellar
peduncles.
What are the symptoms of anterior inferior cerebellar artery stroke?
Vomiting, vertigo, nystagmus. Paralysis of face, lacrimation, salivation, taste from anterior 2⁄3 of tongue. Ipsilateral pain and temperature of the face, contralateral pain and temperature of the body.
Ataxia, dysmetria.
What is lateral pontine syndrome?
AICA lesion. Facial nucleus is specific to AICA. Facial droop means AICA is pooped.
What areas are affected by basilar artery stroke?
Pons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, paramedian pontine reticular formation.
What are the symptoms of basilar artery stroke?
Preserved consciousness and
blinking, quadriplegia, loss of
voluntary facial, mouth, and
tongue movements. -“locked in syndrome”
What areas are affected by posterior cerebral artery stroke?
Occipital cortex, visual cortex.
What are the symptoms of posterior cerebral artery stroke?
Contralateral hemianopia w/ macular sparing.
What areas are affected by lenticulostriate artery stroke?
Striatum, internal capsule.
What are the symptoms of lenticulostriate artery stroke?
contralateral hemiparesis/hemiplegia.
What are lenticulostriate artery lesions commonly associated with?
Common location of lacunar infarcts secondary to unmanaged hypertension.
What areas are affected by anterior cerebral artery stroke?
Motor cortex - lower limb
Sensory cortex - lower limb
What are the symptoms of ACA artery stroke?
Contralateral paralysis—lower
limb.
Contralateral loss of sensation—
lower limb.
What are the areas affected by MCA stroke?
Motor cortex—upper limb and face.
Sensory cortex—upper limb and face.
Temporal lobe (Wernicke area);
frontal lobe (Broca area).
What are the symptoms of MCA stroke?
Contralateral paralysis—upper
limb and face.
Contralateral loss of sensation—
upper limb and face.
Aphasia if in dominant (usually left) hemisphere.
Hemineglect if lesion affects nondominant
(usually right) side.
What are the watershed zones of the brain?
Between ACA and MCA, between MCA and PCA. Damaged in severe hypotension –> upper leg/upper arm weakness, defects in higher order visual processing.
