CVA Clinical Syndromes

Question 1

Anterior Cerebral Artery (ACA) Infarct

Answer 1

–Contralateral hemi-motor deficits LE > UE
–Contralateral hemi-sensory loss LE > UE
–Apraxia (dominant > non-dominant)
–Bilateral integration deficits
–Transcortical Aphasia (dominant > non-dominant)
–Urinary incontinence
–Visual deficits (visual fields)
–Significant cognitive deficits

Question 2

Middle Cerebral Artery (MCA) Infarct

Answer 2

–Contralateral hemi-motor loss UE > LE
–Contralateral hemisensory loss UE > LE
–Dysarthria
–Apraxia (dominant > non-dominant)
–Aphasia (broca’s, wernicke’s, global)

–Perceptual Deficits (non-dominant > -dominant)
–Behavioral impairments
Dominant: cautious
Nondominant: impulsive
–Visual deficits (visual fields, smooth pursuits, saccades)
–Contralateral dysconjugate gaze

Question 3

MCA Lacunar Infarct

Answer 3

Internal capsule damage (3 scenarios):
1) “Pure motor hemiparesis”
2) Motor + sensory deficits
3) Cognitive and behavioral deficits

Basal ganglia damage:
Significant motor control & motor planning deficits

Question 4

Internal Carotid Artery (ICA) Infarct

Answer 4

–ACA + MCA lost
–UE & LE deficits
–Impairments tend to be significant

Question 5

Posterior Cerebral Artery (PCA) Infarct

Peripheral territory

Answer 5

–Contralateral homonymous hemianopsia
–Cortical blindness (bilateral infarcts)
–Visual agnosia (dominant > non-dominant)
–Prosopagnosia
–Memory impairment
–Topographical disorientation (non-dominant > dominant)
–Dyslexia

Question 6

Posterior Cerebral Artery (PCA) Infarct

Deep territory

Answer 6

–Thalamic pain
–Spontaneous pain & dysesthesias
–Involuntary movements
–Contralateral hemiplegia

Question 7

ACA-MCA Watershed Infarct

Answer 7

–Proximal limb involvement
–“Man in the barrel” syndrome
–Dominant hemisphere: transcortical aphasia

Question 8

MCA-PCA Watershed Infarct

Answer 8

–Disturbances in higher-order visual processing
–Cortical blindness possible

Question 9

Common characteristics of RIGHT hemispheric damage

Answer 9

–Perceptual deficits are more common
–Quick, impulsive behavior
–Fair insight, poor judgment, unrealistic
–Inability to self-correct
–Difficulty perceiving emotions
–Difficulty problem solving
–Rigidity of thought

Question 10

Common characteristics of LEFT hemispheric damage

Answer 10

–Language deficits are more common
–Cautious, slow
–Disorganized
–Hyper-aware of deficits
–Difficulty expressing emotions, flat affect
–Disorganized thought process
–Difficulty initiating tasks
–Perseveration

Question 11

Superior Cerebellar Artery (SCA) Infarct

Answer 11

–Ipsilateral Ataxia - truncal and appendicular
–Ipsilateral oculomotor impairment - smooth pursuit and saccades

Question 12

Medial pontine syndrome

Answer 12

paramedian branches of basilar artery

–Ipsilateral paralysis of conjugate gaze (will cause diplopia)
–Contralateral ataxia
–Contralateral facial & body weakness
–Contralateral sensory facial & body sensory loss (dorsal column)

Question 13

Lateral pontine syndrome

Answer 13

AICA

–Nystagmus (causes vertigo, nausea, vomiting)
–Ipsilateral facial weakness
–Ipsilateral facial sensory loss (temp and pain)
–Ipsilateral hearing loss, tinnitus
–Ipsilateral ataxia
–Contralateral body sensory loss (anterolateral system)

Question 14

Lateral medullary syndrome (Wallenberg’s Syndrome)

Answer 14

PICA or vertebral artery

–Ipsilateral facial pain/temp loss
–Contralateral body sensory loss (anterolateral systems)
–Ipsilateral ataxia
–Nystagmus (causes vertigo, nausea, vomiting)
–Dysphagia, dysphonia, impaired gag reflex
–Due to palatal and laryngeal paralysis
Ipsilateral Horner’s Syndrome
>Miosis
>Ptosis
>Anhidrosis

Question 15

Medial medullary syndrome

Answer 15

vertebral artery

–Ipsilateral tongue weakness
–Contralateral body weakness
–Contralateral body sensory loss (dorsal column)

Question 16

Vertebrobasilar artery syndrome (Locked-In Syndrome)

Answer 16

–Complete tetraplegia
–Bilateral cranial nerve palsy

Upward gaze spared
Blink spared
COGNITION SPARED