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66 Cards in this Set
- Front
- Back
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the blood supply of the anterior circulation of the brain
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Internal Carotid
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Cerebral arteries that the internal carotid supplies
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ACA
MCA |
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blood supply of the posterior circulation of the brain
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vertebral arteries
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vertebral arteries join together to form what
located where |
basilar artery
anterior surface of pons |
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TIA in which there is loss of vision in one eye
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amaurosis fugax
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amaurosis fugax indicates what
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extracranial carotid artery disease
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internal carotid artery occlusion can lead to what
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asymptomatic
amaurosis fugax MCA stroke ACA/MCA stroke |
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features common to both right and left MCA stroke
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contralateral hemiparesis and sensory impairment - face and arm
contralateral homonymous hemianopsia fixed gaze to side of stroke |
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additional features seen in MCA stroke in the dominant hemisphere (LEFT)
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Wernicke's
Broca's aphasia or Gerstmann's syndrome |
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differentiate occlusion in Wernick's vs. Broca's aphasia
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Broca's - anterior branch of MCA
Wernicke's - posterior branch of MCA |
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characteristics of gertmann's syndrome
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left-right confusion
finger agnosia acalculia agrphia |
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location of occlusion if patient presents with gerstman's syndrome
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end of the posterior branch of MCA
angular and supramarginal gyrus infarction |
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features seen in MCA stroke of non-dominant hemisphere (RIGHT)
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anosognosia - denial of illness
asomatosognosia - denial of own body parts |
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characteristics of ACA stroke
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contralateral hemiparesis and sensory impairment - leg
urinary incontinence frontal lobe release signs - usually seen in infancy |
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what is seen if bilateral ACA's are involved
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abulia (lack of will or emotion), slowness in responding
frontal lobe release signs |
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patients presents with:
contralateral hemiplegia and hemisensory loss contralateral homonymous hemianopsia with some spared in middle |
anterior choroidal artery stroke
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comes off the internal carotid just above the origin of the posterior communicating artery
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anterior choroidal artery
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areas supplied by the anterior choroidal artery
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posterior limb of Internal capsule
GPi Optic tract choroid plexus in lateral ventricle |
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main difference between MCA and anterior choroidal artery stroke
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no cortical signs seen in anterior choroidal artery stroke - aphasias or agnosias
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hallmark findings of a posterior circulation stroke
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crossed findings - ipsilateral cranial nerve, contralateral body
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trauma or chiropractic manipulation can lead to what
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occlusion of the vertebral artery - most often PICA which leads to lateral medullary syndrome
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occlusion of the distal vertebral artery results in what
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occlusion of the anterior spinal artery - medial medullary syndrome
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findings in medial medullary syndrome
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contralateral hemiplegia
contralateral loss of vibration and proprioception ipsilateral tongue weakness |
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what three nuclei are involved in medial medullary syndrome
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medullary pyramid
medial lemniscus hypoglossal nucleus |
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occlusion of PICA leads to what
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lateral medullary syndrome (wallenberg's syndrome)
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findings in lateral medullary syndrome
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contralateral sensory loss in body
ipsilateral sensory loss in face ipsilateral Horner's syndrome limb ataxia Hoarseness dysphagia hiccups nystagmus nausea vomiting |
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nucleus involved with lateral medullary syndrome
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STT - contralateral body
CN V - ipsilateral face descending sympathetics - Horner's syndrome cerebellum - ataxia nucleus ambiguous - hoarseness, dysphagia, hiccups vestibular nuclei - nausea, nystagmus, vomiting |
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Area supplied by AICA
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ventral cerebellum
middle cerebellar peduncle pontine tegmentum |
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findings in AICA stroke
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very similar to PICA stroke except there is ipsilateral hearing loss and tinnitus involved due to chochlear and labyrinthing infarction
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findings in superior cerebellar artery stroke
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ipsilateral ataxia
ipsilateral tremor occasionally with choreiform dyskinesia hearing loss contralteral sensory loss pseudobulbar speech |
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this artery supplies the superior cerebellar peduncle, dentate nucleus, and STT
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Superior cerebellar artery
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differentiate the arteries that supply the superior, middle, and inferior cerebellar peduncles
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superior - superior cerebellar artery
middle - anterior inferior cerebellar artery inferior - posterior inferior cerebellar artery |
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a stroke in this artery may cause: bilateral motor, sensory, cerebellar, and CN deficits
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basilar artery
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locked-in syndrome
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basilar artery stroke with sparing of the reticular activating system - patient can only communicate by looking up or down
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findings in a stroke in the lateral pons
which artery is involved |
basilar artery:
ipsilateral 6th and 7th CN palsy contralteral hemiplegia ipsilateral ataxia may also be present |
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stroke involving the PPRF-6th nerve complex
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eyes are fixated toward the contralateral hemiplegia
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stroke involving the MLF pathway
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patients complain of double vision and an INO will be found
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Weber's syndrome
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occlusion in the proximal PCA:
ipsilateral 3rd nerve palsy contralateral hemiparesis contralateral hemisensory loss |
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findings in a distal PCA occlusion
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contralateral homonymous hemianopsia with macular sparing
memory difficulties DOES NOT HAVE: aphasia, hemiparesis and hemisensory loss seen in MCA stroke |
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bilateral PCA stroke
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results in cortical blindness
may be sector of vision that is preserved but cannot synthesize the parts into a whole - simultanagnosia |
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Anton syndrome
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bilateral PCA stroke with patients denying the loss of vision
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Bilateral mesiotemporal-occipital stroke
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proposopagnosia - inability to recognize faces
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lacunar strokes
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small vessel strokes
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stroke involving motor fibers of the posterior limb of the internal capsule
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lenticulostriate branch of the MCA
pure motor stroke |
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absence of any abnormalities other than pure UMN weakness
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pure motor stroke - weakness of the contralateral face, arm, and leg in the absence of any sensory involvement
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sudden loss of sensation, numbness and tingling of the face, arm, and leg
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pure sensory stroke - infarction in the thalamus (VPM and VPL) and/or sensory fibers in the posterior limb of the internal capsule
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occlusion of the thalamogeniculate branch of the PCA
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pure sensory stroke
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patient presents with sudden onset wild, flinging movements on one side of the body
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hemiballismus - stroke in the contralateral subthalamic nucleus
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multiple subcortical strokes can lead to what
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pseudobulbar palsy with profound dysarthria, dysphagia, emotional incontinence, and cognitive deficits
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different types of intracerebral hemorrhages from chronic hypertension
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putaminal
thalamic pontine cerebellar |
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associated with charcot-bouchard aneurysms
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hypertension causing these aneurysms and rupturing into cerebral parenchyma
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most common location for hypertensive hemorrhage
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putamin
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patient presents with:
contralateral hemiplegia contralateral hemisensory increased ICP with headache, nausea and cognitive deficits that can lead to coma |
putaminal hemorrhage
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patient presents with:
contralateral sensory contralateral motor deficits limitation of vertical eye movements |
thalamic hemorrhage
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patients presents with abrupt loss of consciousness and pinpoint pupils
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pontine hemorrhage
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patient presents with occipital headache, nausea, vomiting, vertigo, ipsilateral ataxia, and nystagmus
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cerebellar hemorrhage
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only intracerebral hemorrhage that can be treated via surgery
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cerebellar hemorrhage
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caused by saccular/berry aneurysms
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subarachnoid hemorrhage
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associated with hypertension, smoking, polycystic kidney disease
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berry aneurysms
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do patients with berry aneurysms have symptoms
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asymptomatic until rupture
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symptoms of ruptured berry aneurysm
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acute, very severe headache
increased ICP - confusion, nausea, vomiting, loss of consciousness. Usually lacks localized findings except CN III palsy is common in posterior communicating artery aneurysm rupture |
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associated with CN III palsy and Increased ICP
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rupture of posterior communicating artery aneurysm
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how to confirm diagnosis of ruptured berry aneurysm
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head CT
if CT normal, lumbar puncture to look for blood |
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what if there is occlusion of the proximal ACA
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involve territory of medial lenticulostriate artery which will also have pure motor weakness of contralateral face and arm.
this is in edition to hemiparesis and sensory impairment of leg and urinary incontinence |
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differentiate hemiparesis and hemisensory loss in an MCA stroke proximal and distal to the lenticulostriate branches
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proximal - involve face, arm and leg
distal - face and arm, less leg invovlement |
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associated occlusion of the anterior spinal artery distribution
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medial medullary syndrome
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