Vascular Syndroms/Lesions

Question 1

Acute central cervical spinal cord syndrome

Answer 1

occlusion of the anterior spinal artery
bilateral paresis or flaccid paralysis of UE, hyperactive reflexes (lateral corticospinal tracts/ventral gray horns)
irregular loss of pain/temp bilaterally over body below lesion (ALS)

Question 2

thrombosis of anterior spinal artery

Answer 2

bilateral flaccid paraplegia or quadriplegia
urinary retention
loss of pain/temp sensation
hyperactive reflexes and Babinski reflexes
paralysis of respiratory muscles at high cervical levels

Question 3

Foix-Alajouanine syndrome

Answer 3

inflammation of spinal veins that results in infarct of spinal cord and necrotic myelitis
ascending pain and flaccid paralysis

Question 4

spinal AVM symptoms

Answer 4

micturition problems
motor deficits
lower back pain

Question 5

Brown-Sequard syndrome

Answer 5

functional hemisection of the spinal cord
contralateral loss of pain/temp sensation (ALS)
ipsilateral loss of discriminative touch/proprioception (dorsal column)
ipsilateral paralysis below lesion (lateral corticospinal fibers

Question 6

syringomyelia

Answer 6

cavitation in central region of spinal cord
bilateral loss of pain/temp sensation - usually cape-like distribution (anterior white commissure)
lower motor neuron deficit - unilateral or bilateral paralysis of UE (spinal motor neuron damage)

Question 7

medial medullary syndrome

Answer 7

occlusion of anterior spinal artery
contralateral hemiplesia of UE, trunk, and LE (pyramids)
contralateral loss of position sense, vibratory sense, and discriminatory touch (ML)
deviation of tongue to ipsilateral side (hypoglossal nerve/nucleus)

Question 8

lateral medullary syndrome (Wallenburg)

Answer 8

occlusion of PICA
contralateral loss of pain/temp (ALS)
ipsilateral loss of pain/temp on face (spinal trigeminal tract and nucleus)
dysphagia, soft palate paralysis, hoarseness, diminished gag reflex (nucleus ambiguous)
ipsilateral Horner syndromd - miosis, ptosis, anhydrosis (descending hypothalamic fibers)
vestibular problems - nausea, diplopia, fall to ipsilateral side, nystagmus (vestibular nuclei)
ataxis to ipsilateral side (restiform body and spinocerebellar fibers)

Question 9

tonsilar herniation

Answer 9

herniation of cerebellar tonsil down through foramen magnum - compresses medulla
sudden respiratory and cardiac arrest (damage to respiratory and cardiac centers)

Question 10

syringobulbia

Answer 10

weakness of tongue muscles (hypoglossal nucleus/nerve)
weakness of pharyngeal, palatal, and vocal musculature (ambiguus nucleus)
nystagmus (vestibular nuclei)
loss of pain/temp on ipsilateral face (spinal trigeminal tract and nucleus/crossing ventral trigeminothalamic fibers)

Question 11

Medial pontine syndrome

Answer 11

occlusion of paramedian branches of basilar
contralateral hemiplesia (corticospinal fibers in basilar pons)
contralateral loss of position/vibratory sense/discriminative touch (medial lemniscus)
ipsilateral lateral rectus paralysis (abducens nerve/nucleus)
paralysis of conjugate gaze toward lesion (PPRF)

Question 12

lateral pontine syndrome

Answer 12

occlusion of long circumferential branch of basilar
ataxia, unsteady gate, fall toward lesion side (middle and superior cerebellar peduncle)
vertigo, nausea, nystagmus, deafness, tinnitus (vestibular and cochlear nuclei/nerves)
ipsilateral paralysis of facial muscles (facial motor nucleus)
ipsilateral paralysis of masticatory muscles (trigeminal motor nucleus)
ipsilateral Horner syndrome (descendin ghypothalamic fibers)
contralateral loss of pain/temp sensation (ALS)
ipsilateral loss of pain/temp from face (spinal trigeminal tract and nucleus)
paralysis of conjugate horizontal gaze (PPRF)

Question 13

medial midbrain (Weber) syndrome

Answer 13

occlusion of paramedial branch of PCA
contralateral hemiplesia (corticospinal fibers in crus cerebri)
ipsilateral paralysis of eye movements, down and out eye, fixed and dilated pupil (oculomotor nerve)

Question 14

central midbrain lesion (Claude) syndrome

Answer 14

ipsilateral paralysis of eye movement, eye down and out, pupil fixed and dilated (oculomotor nerve)
contralateral ataxis and tremor of cerebellar origin (red nucleus and cerebrothalamic fibers)

Question 15

Benedikt Syndrome

Answer 15

lesion of the midbrain involving both medial (weber) and central (claude) syndromes

Question 16

Parinaud Syndrome

Answer 16

caused by a tumor in the pineal region
paralysis of upward gaze (superior colliculi), hydrocephalus (occlusion of cerebral aqueduct), failure of eye movement (trochlear and oculomotor nn), nystagmus (MLF)

Question 17

uncal herniation

Answer 17

extrusion of the uncus through the tentorial notch
ipsilateral oculomotor palsy - pupils fully dilated, weakness of eye movements (oculomotor nerve)
contralateral hemiplesia (crus cerebri)

Question 18

Kernohan syndrome

Answer 18

oculomotor palsy and hemiplesia of UE and LE both on the same side of the body (oculomotor nerve damaged on ipsilateral side, which crus cerebri on the contralateral side is impaled against the edge of the tentorium cerebelli)

Question 19

decorticate rigidity (due to supratentorial lesions)

Answer 19

flexion of forearm, wrist, and fingers with adduction of UE; extension of LE with internal rotation and plantar flexion of foot)

Question 20

decerebrate rigidity (due to infratentorial lesions)

Answer 20

UE and LE extended, toes pointed inward, forearm pronated, and head and neck extended - opisthotonos

Question 21

bilateral paresis or flaccid paralysis of UE

Answer 21

medial portions of both lateral coritospinal tracts; ventral gray horns at cervical levels

Question 22

loss of pain/temp sensation bilaterally over body below lesion

Answer 22

ALS in spinal cord

Question 23

contralateral hemiplesia of UE, trunk and LE

Answer 23

pyramid/corticospinal fibers

Question 24

contralateral loss of position sense, vibratory sense and discriminative touch

Answer 24

medial lemniscus

Question 25

deviation of tongue to ipsilateral side when protruded

Answer 25

hypoglossal nerve in medulla or hypoglossal nucleus

Question 26

contralateral loss of pain/temp sense on body

Answer 26

ALS

Question 27

ipsilateral loss of pain/temp sense on face

Answer 27

spinal trigeminal tract and nucleus

Question 28

dysphagia, soft palate paralysis hoarseness, diminished gag reflex

Answer 28

nucleus ambiguus, roots of IX and X

Question 29

ipsilateral Horner syndrome (miosis, ptosis, anhidrosis, flushing of face)

Answer 29

descending hypothalamospinal fibers

Question 30

nausea, diplopia, tendency to fall to ipsilateral side, nystagmus, vertigo

Answer 30

vestibular nucleus (mainly inferior and medial)

Question 31

ataxia to the ipsilateral side

Answer 31

restiform body and spinocerebellar fibers

Question 32

ipsilateral lateral rectus muscle paralysis

Answer 32

abducens nerve fibers or nucleus

Question 33

paralysis of conjugate gaze toward side of lesion

Answer 33

paramedian pontine reticular formation (PPRF)

Question 34

ataxia, unsteady gait, fall toward side of lesion

Answer 34

middle and superior cerebellar peduncles

Question 35

vertigo, nausea, nystagmus, deafness, tinnitus, vomiting

Answer 35

vestibular and cochlear nerves and nuclei

Question 36

ipsilateral paralysis of facial muscles

Answer 36

facial motor nucleus

Question 37

ipsilateral paralysis of masticatory muscles

Answer 37

trigeminal motor nucleus

Question 38

ipsilateral paralysis of eye movement; eye oriented down and out and pupil dilated and fixed

Answer 38

oculomotor nerve

Question 39

contralateral ataxia and tremor of cerebellar origin

Answer 39

red nucleus and cerebellothalamic fibers

Question 40

lesions of the subthalamic nucleus

Answer 40

hemiballismus - rapid and unpredictable flailing movements of the contralateral extremities

Question 41

occlusion of lenticulostriate branches to internal capsule

Answer 41

``` contralateral hemiplegia (corticospinal fibers) loss/diminution of sensory perception (thalamocortical fibers traversing posterior limb to sensor cortex) ```

Question 42

infarction of posterior thalamic nuclei

Answer 42

contralateral complete sensory loss (posterior thalamic regions)

Question 43

occlusion of distal branches of A- or M- CA

Answer 43

motor and sensory losses in contralateral foot, leg and thigh (damage to the a and p paracentral gyri) - if it spares the leg and foot, it's the MCA

Question 44

anterior watershed infarct (ACA-MCA junction)

Answer 44

contralateral hemiparesis and expressive language or behavior changes

Question 45

posterior watershed infarct (MCA-PCA junction)

Answer 45

visual deficits and language problems

Question 46

anterior choroidal artery syndrome

Answer 46

contralateral homonymous hemianopia (optic tract) contralateral hemiplegia (corticospinal fibers at transition of internal capsule into the crus cerebri) hemianesthesia on the same side as the hemiplegia (if thalamocortical fibers from VPL to somatosensory cortex are also damaged)

Question 47

Parkinson's disease

Answer 47

loss of dopamine-containing cells in substantia nigra | stooped posture, resting tremor, rigidity, shuffling or festinating gate, difficulty initating or maintaining movement

Question 48

anterior choroidal artery syndrome

Answer 48

``` contralateral hemiplesia (crus cerebri) contralateral hemianopia (optic tract damage) ```