Week 1 Zoom- CVA Clinical Syndromes Flashcards
PART 1- ANTERIOR CEREBRAL ARTERY
PART 1- ANTERIOR CEREBRAL ARTERY
The ACA travels through the __________ fissure.
longitudinal
- The ACA provides blood to the ________ and _______ surface of the brain, from the ______ lobe to anterior _______ lobe.
- It also supplies the _______ _________.
- anterior and medial, frontal lobe to anterior parietal lobe
- corpus callosum
What are the signs and symptoms of ACA Syndrome?
- contralateral hemiparesis/hemiplegia LE>UE
- contralateral hemisensory loss LE>UE
- Apraxia
- Problems w/bimanual tasks
- significant cognitive deficits (agitation memory, emotional lability, motor preservation)
- lack of spontaneity, motor inaction, slowness and delay (difficulties with executive function tasks)
- transcortical aphasia
- contralateral grasp reflex, sucking reflex
- “Alien hand syndrome”
- Urinary incontinence
Damage to the medial aspect of the primary motor cortex causes what S/Sx of ACA Syndrome?
contralateral hemiparesis/hemiplegia LE>UE
Damage to the medial aspect of the primary sensory cortex causes what S/Sx of ACA Syndrome?
contralateral hemisensory loss LE>UE
Damage to the supplemental motor area and corpus callosum causes what S/Sx of ACA Syndrome?
apraxia
Damage to the corpus callosum alone causes what S/Sx of ACA Syndrome?
problems with bimanual tasks
Damage to the frontal cortex causes what S/Sx of ACA Syndrome?
significant cognitive deficits (agitation, memory, emotional lability, motor preservation)
Damage to the pre-frontal cortex causes what S/Sx of ACA Syndrome?
- lack of spontaneity, motor inaction, slowness and delay
- difficulties with executive function tasks
Damage to the dominant hemisphere supplemental motor area causes what S/Sx of ACA Syndrome?
transcortical aphasia
Damage to the posteromedial aspect of superior frontal gyrus causes what S/Sx of ACA Syndrome?
urinary incontinence
What are the main differences in the presentation of a left ACA vs a right ACA?
Left ACA
- transcortical aphasia may be seen
- may see apraxia (less common)
Right ACA
-may see L neglect (less common)
PART 2- MIDDLE CEREBRAL ARTERY
PART 2- MIDDE CEREBRAL ARTERY
The MCA splits into ________ and _______ branches, that arise from the MCA ______.
- superior and inferior branches
- MCA stem
- What lobes does the superior MCA branch supply?
- What lobes does the inferior MCA branch supply?
Superior
- lateral and inferior frontal lobe
- anterior and lateral parietal lobe
Inferior
- lateral temporal lobe
- lateral occipital lobe
What are the signs and symptoms of MCA Syndrome?
- contralateral paresis UE/face>LE
- contralateral sensory loss UE/face>LE
- motor speech impairment
- receptive speech impairment
- global aphasia
- perceptual deficits: unilateral neglect, depth perception, spatial relations
- apraxia
- visual deficits
- loss of conjugate gaze to opposite side
- pure motor hemiplegia (lacunar stroke)
What are the main differences in the presentation of a left and right MCA superior division syndrome?
Left MCA Superior Division
- Non-fluent (Broca’s) aphasia
- apraxia
- R visual field loss or dysconjugate gaze
Right MCA Superior Division
- L hemineglect
- L visual field loss or dysconjugate gaze
Both have arm/face weakness and possible sensory deficits
What are the main differences in the presentation of a left and right MCA inferior division syndrome?
Left MCA Inferior Division
- Fluent (Wernicke’s) aphasia
- R visual field loss
Right MCA Inferior Division
- L visual field loss
- profound L hemineglect and other perceptual deficits
Both have arm/face sensory deficits and possible weakness
How will a right/left MCA deep territory syndrome present?
contralateral pure motor hemiparesis
What are the main differences in the presentation of a left and right MCA stem syndrome?
Left MCA Stem
-global aphasia
Right MCA Stem
-L hemineglect and other perceptual deficits
Both have arm/face weakness/sensory deficits as well as visual field loss and dysconjugate gaze
PART 3- POSTERIOR CEREBRAL ARTERY
PART 3- POSTERIOR CEREBRAL ARTERY
The PCA branches off the vertebrobasilir arteries and supplies the ________ lobe and ___________ __________ lobe.
-occipital lobe and posteromedial temporal lobes
What are the signs and symptoms of PCA syndrome?
- contralateral homonymous hemianopsia
- cortical blindness
- visual agnosia
- prosopagnosia
- dyslexia
- memory deficit
- topographic disorientation
Damage to the primary visual cortex or optic radiation causes what S/Sx of PCA Syndrome?
contralateral homonymous hemianopsia
Damage to bilateral occipital lobes causes what S/Sx of PCA Syndrome?
cortical blindness
Damage to the occipital lobe (dominant side) causes what S/Sx of PCA Syndrome?
visual agnosia
Damage to the visual association cortex causes what S/Sx of PCA Syndrome?
prosopagnosia
Damage to the dominant calcarine and posterior part of corpus callosum causes what S/Sx of PCA Syndrome?
dyslexia
Damage to the inferomedial portions of the temporal lobe (dominant side) causes what S/Sx of PCA Syndrome?
memory deficit
Damage to the nondominant primary visual cortex causes what S/Sx of PCA Syndrome?
topographical disorientation
What are the main differences in the presentation of a left and right PCA Syndrome?
Left PCA Syndrome
- R homonymous hemianopia
- memory deficits
- visual agnosia, prosopagnosia
Right PCA Syndrome
- L homonymous hemoanopia
- topographical disorientation
PART 4- SUPERIOR CEREBELLAR ARTERY SYNDROME
PART 4- SUPERIOR CEREBELLAR ARTERY SYNDROME
What are the 2 overarching S/Sx of Superior Cerebellar Artery Syndrome?
- Ipsilateral cerebellar symptoms
- Horner’s Syndrome
What are the cerebellar symptoms of Superior Cerebellar Artery Syndrome?
-cerebellar ataxia
-dizziness
0horizontal nystagmus
-dysconjugate gaze
What are the symptoms of Horner’s Syndrome?
- Ptosis (drooping eyelid)
- Miosis (pupil constriction)
- Anhidrosis (decreased sweating)
- Enophthalmos
- ipsilateral dorsal column loss, contralateral spinothalamic loss
- dysphagia, dysphonia
PART 5- MEDIAL MEDULLARY SYNDROME
PART 5- MEDIAL MEDULLARY SYNDROME
Medial Medullary Syndrome involves occlusion to _______ _________ artery or medial medullary branches of the __________ artery.
- anterior spinal
- vertebral
What are the 4 M’s of areas affected by Medial Medullary Syndrome?
- Motor pathway of (corticospinal tract)
- Medial lemniscus
- Medial longitudinal fasciculus
- Motor pathway of (hypoglossal nerve)
What are the S/Sx of Medial Medullary Syndrome?
- contralateral UE/LE hemiparesis
- contralateral loss of discriminative touch, vibratory and proprioception sense on body
- ipsilateral internuclear ophthalmoplegia (failure of adduction of ipsilateral eye towards nose i.e. CN III function and nystagmus in the opposite eye as it looks laterally i.e. CN VI)
- ipsilateral paralysis of tongue with tongue deviation on protrusion towards affected side
PART 6- LATERAL MEDULLARY SYNDROME (WALLENBURG’S SYNDROME)
PART 6- LATERAL MEDULLARY SYNDROME (WALLENBURG’S SYNDROME)
Lateral Medullary Syndrome involves occlusion of the _________ _________ _________ artery or _________ artery.
- posterior inferior cerebellar
- vertebral
What are the key areas affected by Lateral Medullary Syndrome?
medulla oblongata, choroid plexus of 4th ventricle, dentate nucleus, main supplier of blood to cerebellum
What are the S/Sx of Lateral Medullary Syndrome?
- vertigo
- N/V
- nystagmus
- ataxia
- balance and gait coordination problems
- ipsilateral facial pain/temp loss
- contralateral body pain/temp loss
PART 7- MEDIAL INFERIOR PONTINE SYNDROME
PART 7- MEDIAL INFERIOR PONTINE SYNDROME
Medial Inferior Pontine Syndrome involves occlusion of the paramedian branch of the ________ artery.
basilar
What are the key areas affected by Medial Inferior Pontine Syndrome?
CN VI nucleus, medial lemniscus, pontine center, vestibular nuclei, middle cerebellar peduncle, CST and corticobulbar tracts
What are the S/Sx of Medial Inferior Pontine Syndrome?
- ipsilateral dysconjugate gaze
- ipsilateral nystagmus
- ipsilateral diplopia on lateral gaze
- ipsilateral paresis of face
- contralateral paresis of UE and LE
- contralateral tactile and proprioception
PART 8- LATERAL INFERIOR PONTINE SYNDROME
PART 8- LATERAL INFERIOR PONTINE SYNDROME
Lateral Inferior Pontine Syndrome involves occlusion of the ________ _______ __________ artery, branch of the __________ artery.
- anterior inferior cerebellar
- basilar
What are the key areas affected by Lateral Inferior Pontine Syndrome?
-CNV (sensory), VII, and VIII nuclei, pontine center, middle cerebral peduncle, cerebellar hemisphere
What are the S/Sx of Lateral Inferior Pontine Syndrome?
- nystagmus
- vertigo
- N/V
- ipsilateral facial paralysis and sensory loss
- ipsilateral dysconjugate gaze
- hearing loss
- ataxia
- contralateral pain/temp loss of body
PART 9- LOCKED IN SYNDROME
PART (- LOCKED IN SYNDROME
Locked In Syndrome involves occlusion of the _______ artery leading to bilateral ventral pontine infarct.
basilar
What are the S/Sx of Locked In Syndrome?
- acute hemiparesis that progresses to full body tetraplegia
- lower bulbar paralysis (4-12 involvement)(upward eye movements and blinking only thing spared)
- mutism (loss of voice)
- cognition is spared
