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Question 1

Stroke patient has aphasia: fluent speech, impaired comprehension, and preserved repetition of words. Which anatomical structure is most likely damaged?
A. Temporo-occipital cortex
B. Posterior-superior temporal gyrus
C. Poster-inferior frontal lobe
D. Parietal Operculum

Answer 1

A. Temporo-occipital cortex.

Symptoms consistent with transcortical sensory aphasia.

• Lesion to posterior part of superior temporal gyrus would produce Wernicke’s aphasia: fluent, impaired comprehension, impaired repetition.
• Parietal operculum (arcuate fasiculus) connects Broca’s and Wernicke’s area. This leads to normal fluency and comprehension, but impaired repetition. Conduction aphasia.
• Lesion in posterior-inferior frontal lobe would produce non-fluent speech, preserved comprehension, and impaired repetition. Broca’s aphasia.

Question 2

Impingement of nerve root exiting at the level (below C6). What symptoms would you see on physical exam?
A. Little finger paresthesia
B. Middle finger paresthesia
C. Elbow flexion weakness
D. Wrist extension weakness

Answer 2

B. Middle finger paresthesia

Cervical nerve roots exits at the level above the names vertebra except C8, which exits above T1. C7 nerve root is affected. C7 is most commonly affected, followed by C6. Younger patients, radiculopathy affected by disc herniation. Older patients usually degenerative changes.

• C5 radic: elbow flexion weakness, lateral antecubital fossa paresthesia
• C6 radic: wrist extension weakness, thumb paresthesias
• C7 radic: elbow extension weakness, middle finger parasthesias
• C8 radic: finger flexion weakness, little finger paresthesias

Question 3

New stroke evaluation. extraocular movements: right eye has difficulty with abduction looking to the right. There is also right facial droop, and left sided hemiplegia. Which artery was involved in the patient’s stroke?
A. Right circumferential branches of the basilar artery
B. Right interpenduncular branches of the posterior cerebral artery
C. Left interpenduncular branches of the posterior cerebral artery
D. Left circumferential branches of the basilar artery

Answer 3

A. Right circumferential branches of the basilar artery

Symptoms consistent with Millard - Gubler syndrome. Lesion to pons that affects CN 6 and 7 resulting in ipsi CN 6 and 7 palsies (impaired lateral rectus thus abducting the eye is impaired, and left facial weakness), contra hemiplegia.

Interpenduncular branches of the PCA are implicated in Weber syndrome (midbrain)/. CN 3 affected on ipsi - contra hemiplegia and contra Parkinson symptoms.