Common presentations and Lesions Flashcards Preview

Vascular Neurology EK > Common presentations and Lesions > Flashcards

Flashcards in Common presentations and Lesions Deck (59):
1

Ipsilateral third nerve palsy and contralateral hemiplegia

Weber's syndrome (midbrain lesion)

2

Ipsilateral third nerve palsy and contralateral involuntary movements

Benedikt's Syndrome (lesion in the ventral portion of the mesencephalic tegmentum)

3

Ipsilateral third nerve palsy and contralateral ataxia and tremor

Claude's syndrome (lesion in the dorsal portion of the mesencephalic tegmentum)

4

Ipsilateral seventh nerve palsy with contralateral hemiplegia

Millard-Gubler syndrome (lesion in the pons)

5

Limited upward gaze, convergence retraction nystagmus, light-near dissociation, lid retraction and skew deviation of the eyes

Parinaud's syndrome (lesion in the quadrigmeminal plate)

6

Quadriplegia, inability to speak, limited horizontal gaze, with preserved consciousness, vertical gaze and blinking

Locked-in syndrome

7

Vertigo, nystagmus, nausea, hiccups, hoarseness, dysphagia, ipsilateral paralysis of the palate and vocal cord, decreased gag reflex, impaired sensation on the ipsilateral hemiface, loss of sensation to pain and temperature in the contralateral hemibody, ipsilateral ataxia and lateropulsion, and ipsilateral Horner's syndrome

Wallenberg's syndrome: caused by a lateral medullary infarction (associated with posterior inferior cerebellar artery or vertebral artery occlusion)

8

Ipsilateral hearing loss, vertigo, ipsilateral ataxia, ipsilateral Horner's syndrome, sensory deficits in the ipsilateral hemiface and contralateral hemibody

Anterior inferior cerebellar artery infarct

9

Contralateral hemibody sensory loss with subsequent development of pain, allodynia, and parasthesia

Dejerine- Roussy syndrome, results from a thalamic lesion

10

Finger agnosia, right left disorientation, agraphia and acalculia

Gerstmann's Syndrome - dominant parietal lobe infarct

11

Normal variant with vascular supply to both medial thalami

Artery of percheron

12

Deep branch from the ACA that supplies anterior limb of the internal capsule, inferior part of head of caudate nucleus, and anterior part of globus pallidus

recurrent artery of Heubner

13

Caused by chronic hypertension, and associated with the pathogenesis of lacunar strokes

Lipohyallinosis

14

Infarct between two vascular territories produces the "person in a barrel" syndrome characterized by proximal weakness

Watershed infarcts

15

Behavioural abnormalities, altered level of consciousness, and abnormalities of ocular motion

Top of basilar syndrome -
Infarct in the posterior circulation from thrombus lodging in the distal basillar

16

right hemiparesis, right homonoymous hemianopia and aphasia

Left MCA syndrome

17

Left hemiparesis, left homonymous hemianopia and left hemineglect

Right MCA syndrome

18

Thalamus, contralateral hemisensory loss

pure sensory lacunar syndrome

19

Posterior limb of internal capsule, contralateral motor deficits. Also described with ventral pons lacunes

Pure motor lacunar syndrome

20

Paramedian pons "clumsy hand" and dysarthria

clumsy hand dysarthria lacunar syndrome

21

Pons, midbrain or internal capsule, weakness with ataxia out of proportion to weakness

Ataxic hemiparesis lacunar syndrome

22

NOTCH3

CADASIL: cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

23

Dilated thin-walled vessels, with no smooth muscle of elastic fibers, and no intervening brain parenchyma (popcorn appearance on MRI)

Cavernous malformation

24

Thin walled venous structure with normal intervening brain tissue

venous angioma

25

Abnormally dilated capillaries, normal intervening brain tissue

Capillary telangiectasia

26

Nidus, with arteries and veins communicating without intervening normal capillary bed in between

Arteriovenous malformation

27

Haemorrhage in the putamen, caudate, thalamus, pons, cerebellum, and deep white matter - associated with lipohyalinosis and charcot bouchard microaneurysms

hypertensive intracranial haemorrhage

28

Lobar haemorrhages
Multiple microhaemorrhages on MRI gradient echo
Congo-red positive amyloid material, seen as apple-green birefringence with polarized light

cerebral amyloid angiopathy

29

"Puff of smoke"

Extensive collateral circulation seen in Moyamoya disease, in which there is bilateral stenosis of the distal internal carotid arteries and intracranial arteries of the circle of Willis

30

Internal carotid artery

Ipsilateral retinal ischemia (amaurosis)
Sensorimotor dysfunction similar to involvement of middle and anterior cerebral artery territories

31

Middle cerebral artery, M1 segment

contralateral face and arm (more than leg) weakness
Aphasia (dominant hemisphere)
Contralateral sensory loss
Cortical sensory loss (nondominant hemisphere)
Contralateral visual field defect
gaze deviation ipsilateral to lesion

32

Middle cerebral artery, anterior devision

Contralateral face and arm weakness
Broca aphasia (dominant hemisphere)

33

Middle cerebral artery, posterior division

contralateral sensory loss
Wernickes aphasia (dominant hemisphere)
Gerstmann syndrome (dominant hemisphere)
Cortical sensory loss or neglect (non-dominant hemisphere)
Contralateral visual field defect

34

Anterior cerebral artery

Contralateral leg weakness
Contralateral leg sensory loss
Apraxia
Abulia (bilateral)

35

Anterior choroidal artery

Contralateral homonymous hemianopia (lateral geniculate body)
Contralateral facial, arm, leg weakness (posterior limb of internal capsule)
Contralateral facial, arm, leg sensory loss (thalamus)

36

Posterior cerebral artery, precommunicating part

contralateral sensory loss (thalamus)
Cognitive dysfunction (thalamus)
Thalamic aphasia (rarely)
Visual dysfunction as for postommunicating segment

37

Posterior cerebral artery, posterior communicating part

contralateral homonymous hemianopia
Visual agnosias

38

Posterior inferior cerebellar artery

Horners
Ipsilateral hemiataxia
Ipsilateral palatal weakness
Hoarse voice
Decreased pain and temperature on ipsilateral portion of face and contralateral limbs

39

Anterior inferior cerebellar artery

ipsilateral deafness
Ipsilateral facial weakness (LMN)
Ipsilateral hemiataxia
Contralateral sensory loss in limb

40

Superior cerebellar artery

Ipsilateral ataxia
Decreased sensation contralaterally
Diplopia

41

Basilar perforators, median and paramedian pontine perforators

contralateral limb weakness if unilateral, quadriparesis if bilateral
Hemiataxia may develop (crossing pontocerebellar fibers)
CNVI and VII (affecting nuclei or nerve fibers) palsies
Internuclear opthalmoplegia

42

Midbrain basilar, posterior cerebral artery perforators

Ipsilateral nuclear or fascicular CN III palsy
Contralateral facial, arm, leg weakness (corticospinal tracts)
Rubral tremor (red nucleus) may develop
Ataxia (deccusation of superior cerebellar peduncle) may occur

43

Anterior spinal and vertebral perforators to median and paramedian medulla

Ipsilateral tongue weakness (CNXII nucleus or nerve fibers)
Contralateral arm and leg have reduced vibration sensation and proprioception (medial lemniscus)
Contralateral arm and leg weakness (medullary pyramids)

44

Weber syndrome

Medial midbrain
PCA perforators
Contralateral hemiparesis (cerebral peduncle)
Isilateral CN III palsy (fascicles of CN III)
Imparied ipsilateral pupillary reflex (CNIII) and dilated pupil

45

Benedikt Syndrome

Midbrain tegmentum
PCA perforators
Ipsilateral CN III palsy, usually with dilated pupil
Contralateral involuntary movements (red nucleus, subthalamic nucleus)

46

Claude syndrome

Midbrain tegmentum (dorsal)
PCA perforators
Ipsilateral CN III palsy (CN III fascicles)
contralateral hemiataxia and dysmetria (dentatothalamic fibers within the superior cerebellar peduncle)
Contralateral tremor (red nucleus)

47

Nothnagel syndrome

Midbrain
PCA perforators
Ipsilateral III CN palsy
Contralateral hemiataxia (dentothalamic fibers in superior cerebellar peduncle)

48

Millard Gubler Syndrome

Ventral Pons
Basilar artery perforators, median and paramedian perforators
ipsilateral lower motor neuron facial paralysis (CNVII)
Ipsilateral abducens paralysis (CNVI fibres)
Contralateral hemiparesis (corticospinal tract in basis pontis)

49

Foville syndrome

Dorsal pons tegmentum
Basilar artery perforators
Ipsilateral LMN facial paralysis (nucleus or fascicles of CN VII)
Ipsilateral gaze paralysis (nucleu abducens palsy)
Contralateral hemiparesis (corticospinal tract in basis pontis)

50

Ventral pontine syndrome

ventral pons
Basilar artery, paramedian perforators
Ipsilateral CN VI palsy
Contralateral hemiparesis (corticospinal tract in basis pontis)

51

Marie-Foix syndrome

Base of pons
Basilar artery perforators
Ipsilateral cerebellar ataxia (corticopontocerebellar fibers)
Contralateral hemiparesis (corticospinal tract in basis pontis)
Variable contralateral decrfease in pain and temperature sensation (spinothalamic tract involvement)

52

Wallenberg Syndrome

Lateral medulla
PICA
Ipsilateral hemiataxia (inferior cerebellar peduncle)
Dysphagia, hoarseness, ipsilateral palatal weakness (nucleus ambiguus),
Horner syndrome (sympathetic)
Decreased in pain and temperature sensation (spinal tract and nucleus of CN V and lateral spinothalamic tract) on ipsilateral portion of face, contralateral portion of body

53

Dejerine syndrome

Medial medulla
Vertebral artery perforators, anterior spinal artery
Contralateral hemiparesis (medullary pyramid)
Contralateral decrease in vibration or proprioception sensation in limbs (medial lemniscus)
Ipsilateral CN XII palsy

54

Internal capsule

pure motor hemiparesis (contralateral facial, arm, leg)

55

corona radiata

pure motor hemiparesis (contralateral facial, arm, leg)

56

Thalamus (ventral posterolateral and posteromedial nuclei)

pure sensory stroke contralateral facial, arm, leg sensory loss

57

Thalamocapsular

Sensorimotor stroke - contralateral facial, arm, leg weakness and contralateral facial, arm, leg sensory loss

58

Basis pontis, talamocapsular, corona radiata

ataxic hemiparesis stroke - hemiataxia and hemiparesis on same side of body

59

Basis pontis

Clumsy hand dysarthria - facial weakness, dysarthria, slight hemiparesis