Strokes - Locate the lesion

Question 1

What kind of lesions tend to affect the communicating arteries?

Answer 1

Aneuryms

Question 2

Where is the anterior communicating artery?

Answer 2

12:00. Between the two ACAs.

Question 3

What does anterior communicating artery aneurysm cause?

Answer 3

Visual field defects

Question 4

Where are the posterior communicating arteries located?

Answer 4

Between posterior cerebral arteries and middle cerebral arteries (5:00 and 7:00).

Question 5

What does Pcom aneurysm cause?

Answer 5

CN III. Down and out with ptosis and mydriasis.

Question 6

What areas can be involved in posterior circulation strokes?

Answer 6

posterior inferior cerebellar (PICA), anterior spinal (ASA), anterior infererior cerebellar (AICA), basilar, posterior cerebral.

Question 7

What areas are affected by anterior spinal artery stroke?

Answer 7

1. Lateral corticospinal tract.
2. Medial lemniscus.
3. Caudal medulla—hypoglossal nerve.

Question 8

What are the symptoms of anterior spinal artery stroke?

Answer 8

Contralateral hemiparesis—upper 
and lower limbs. 
 contralateral proprioception. 
Ipsilateral hypoglossal dysfunction 
(tongue deviates ipsilaterally).

Question 9

What areas are affected by posterior inferior cerebellar artery stroke?

Answer 9

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

Question 10

What are the symptoms of posterior inferior cerebellar artery stroke?

Answer 10

Vomiting, vertigo, nystagmus; 
decr pain and temperature sensation 
from ipsilateral face and 
contralateral body; DYSPHAGIA, 
HOARSENESS, decr gag reflex; 
ipsilateral Horner syndrome; 
ataxia, dysmetria.

Question 11

What is Wallenburg syndrome?

Answer 11

Laterally medullary stroke - PICA. Nucleus ambiguous is specific to PICA. (Don’t PICA “hoarse” that can’t “eat” – too ambigious!)

Question 12

What areas are affected by anterior inferior cerebellar artery stroke?

Answer 12

Lateral pons—cranial nerve nuclei;
vestibular nuclei, facial nucleus,
spinal trigeminal nucleus, cochlear
nuclei, sympathetic fibers.

Middle and inferior cerebellar
peduncles.

Question 13

What are the symptoms of anterior inferior cerebellar artery stroke?

Answer 13

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.

Question 14

What is lateral pontine syndrome?

Answer 14

AICA lesion. Facial nucleus is specific to AICA. Facial droop means AICA is pooped.

Question 15

What areas are affected by basilar artery stroke?

Answer 15

Pons, medulla, lower midbrain, 
corticospinal and corticobulbar 
tracts, ocular cranial nerve nuclei, 
paramedian pontine reticular 
formation.

Question 16

What are the symptoms of basilar artery stroke?

Answer 16

Preserved consciousness and
blinking, quadriplegia, loss of
voluntary facial, mouth, and
tongue movements. -“locked in syndrome”

Question 17

What areas are affected by posterior cerebral artery stroke?

Answer 17

Occipital cortex, visual cortex.

Question 18

What are the symptoms of posterior cerebral artery stroke?

Answer 18

Contralateral hemianopia w/ macular sparing.

Question 19

What areas are affected by lenticulostriate artery stroke?

Answer 19

Striatum, internal capsule.

Question 20

What are the symptoms of lenticulostriate artery stroke?

Answer 20

contralateral hemiparesis/hemiplegia.

Question 21

What are lenticulostriate artery lesions commonly associated with?

Answer 21

Common location of lacunar infarcts secondary to unmanaged hypertension.

Question 22

What areas are affected by anterior cerebral artery stroke?

Answer 22

Motor cortex - lower limb

Sensory cortex - lower limb

Question 23

What are the symptoms of ACA artery stroke?

Answer 23

Contralateral paralysis—lower
limb.
Contralateral loss of sensation—
lower limb.

Question 24

What are the areas affected by MCA stroke?

Answer 24

Motor cortex—upper limb and face.
Sensory cortex—upper limb and face.
Temporal lobe (Wernicke area);
frontal lobe (Broca area).

Question 25

What are the symptoms of MCA stroke?

Answer 25

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.

Question 26

What are the watershed zones of the brain?

Answer 26

Between ACA and MCA, between MCA and PCA. Damaged in severe hypotension –> upper leg/upper arm weakness, defects in higher order visual processing.