Brain Infarcts

Question 1

PICA - Lateral Medullary Syndrome (Wallenburg)

Answer 1

Spinal Trigeminal: Ipsi pain/temp (face)
Anterolateral: Contral pain/temp (body)
Nucleus Ambiguous: CN X deficits
Vestib Nuc. + Inf. Cerebellar Peduncle: Ipsi Ataxia, nystagmus
Descending Sympathetics: Ipsi Horner
Solitary Nuc/Tract: Ipsi taste loss

Question 2

ASAs + Paramedian from Vertebral - Medial Medullary Syndrome

Answer 2

Pyramidal Tract: Contra arm/leg weakness
Medial Lemniscus: Contra loss of prop., discrim., vib.
Hypoglossal Nuc/Nerve: Ipsi tongue weakness (lick wound)

Question 3

Paramedian Branch of Basilar (medial pons)

Answer 3

Corticospinal/Corticonuclear Contra leg, arm, face weakness
Abducens Nuc: Ipsil horizontal gaze palsy
Medial Lemniscus: Contra prop., vib, discrim
Facial Nerve/Colliculus: Ipsi face weakness
MLF: Internuclear opthalmoplegia (nystagmus in contra eye, loss of adduction of ipsi eye, when gazing contra lesion)

Question 4

AICA (lateral caudal pons)

Answer 4

Mid cerebellar Peduncle: Ipsi ataxia
Vestib. nuc: Vertigo, nystagmus
Trigem Nuc/tract: Ipsi pain/temp (face)
Spinothalamic: Contra pain/temp (body)

Question 5

Superior Cerebellar Artery SCA (dorsolateral rostral pons)

Answer 5

Superior Cerebellar Peduncle + Cerebellum: Ipsi ataxia

Question 6

PCA Branches + Top of Basilar Artery - Weber’s (anterior-medial midbrain)

Answer 6

Occulomotor Nerve Fascicles: Ipsi CN III palsy

Cerebral Peduncle: Contrala hemparesis

Question 7

PCA Branches + Top of Basilar Artery - Claude’s (tegmentum of pons)

Answer 7

Occulomotor Nerve: Ipsi CN III palsy

Red Nuc/Superior Cerebellar Peduncle: Contra ataxia

Question 8

MCA - Left Superior

Answer 8

UMN weakness of right arm/face
Broca’s aphasia
Somatosensory deficits of right arm/face/trunk

Question 9

MCA - Left Inferior

Answer 9

Wernicke’s aphasia
Somatosensory loss of right arm/face/trunk
Right visual field deficit
Possible right weakness, at onset

Question 10

MCA - Left Deep

Answer 10

Right pure motor hemiparesis (UMN)

Aphasia

Question 11

MCA - Left Stem

Answer 11

Sup+Inf+Deep

Question 12

MCA - Right Superior

Answer 12

UMN weakness of arm/face
Left Hemineglect
Somatosensory of left arm/face/trunk

Question 13

MCA - Right Inferior

Answer 13

Pronounced left hemineglect (normal strength)
Left visual field deficit
Somatosensory deficits of left arm/face/trunk
Right gaze preference (onset)

Question 14

MCA - Right Deep

Answer 14

UMN pure motor hemiparesis

Left hemineglect

Question 15

ACA - Left

Answer 15

UMN right leg weakness
Right leg sensory loss
Grasp reflex
Frontral lobe - odd behavior
Aphasia, right hemiplegia possible

Question 16

ACA - Right

Answer 16

UMN left leg weakness
Left leg sensory loss
Grasp reflex
Frontal lobe - odd behavior
Possible hemineglect, left hemiplegia

Question 17

PCA - Left

Answer 17

Right homonymous hemianopsia
If reaches CC splenium: Alexia
If reaches thalamus/internal capsule: Aphasia, right sensory loss, hemiparesis

Question 18

PCA - Right

Answer 18

Left homonymous hemianopsia

If reaches thalamus/internal capsule: Left hemisensory loss, hemiplegia

Question 19

ACA-MCA Watershed (Coronal, Transverse 2:00)

Answer 19

Transcortical Motor Aphasia: Impaired fluency, normal comprehension

Question 20

MCA-PCA Watershed (Coronal, transverse 5:00)

Answer 20

Transcortical Sensory Aphasia: Normal fluency, impaired comprehension

Question 21

Mixed transcortical aphasia

Answer 21

Impaired fluency/comprehension

ACA-MCA + MCA-PCA watershed infarcts