Large-Vessel Clinical Syndromes

Question 1

Internal carotid artery

Answer 1

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

Question 2

Middle cerebral artery (M1)

Answer 2

-Contralateral face and arm > leg weakness -Aphasia (dominant hemisphere) -Contralateral sensory loss -Cortical sensory loss (nondominant hemisphere) -Contralateral visual field defect -Gaze deviation ipsilateral to lesion

Question 3

Middle cerebral artery, anterior division

Answer 3

-Contralateral face and arm > leg weakness -Broca’s aphasia (dominant hemisphere)

Question 4

Middle cerebral artery, posterior division

Answer 4

-Contralateral sensory loss -Wernicke’s aphasia (dominant hemisphere) -Gerstmann’s syndrome (dominant hemisphere) -Cortical sensory loss/neglect (nondominant hemisphere) -Contralateral visual field defect

Question 5

Anterior cerebral artery

Answer 5

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

Question 6

Anterior choroidal artery

Answer 6

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

Question 7

Posterior cerebral artery (precommunicating)

Answer 7

-Contralateral sensory loss (thalamus) -Cognitive dysfunction (thalamus) -Thalamic aphasia (rarely) -Visual dysfunction as for postcommunicating segment

Question 8

Posterior cerebral artery (postcommunicating segment)

Answer 8

-Contralateral homonymous hemianopia -Visual agnosias

Question 9

Posterior inferior cerebellar artery

Answer 9

-Horner’s syndrome -Ipsilateral hemiataxia -Ipsilateral palatal weakness -Hoarse voice -Decreased pain and temperature on ipsilateral face and contralateral limbs

Question 10

Anterior inferior cerebellar artery

Answer 10

-Ipsilateral deafness -Ipsilaeral facial weakness (lower motor neuron) -Ipsilateral hemiataxia -Contralateral sensory loss in limbs

Question 11

Superior cerebellar artery

Answer 11

-Ipsilateral ataxia -Decreased sensation contralaterally -Diplopia

Question 12

Basilar perforators, median and paramedian pontine perforators

Answer 12

-Contralateral limb weakness if unilateral or quadriparesis if bilateral -Hemiataxia may develop (crossing pontocerebellar fibers) -Cranial nerve/nuclear VI and VII palsies Internuclear ophthalmoplegia

Question 13

Midbrain basilar, posterior cerebral artery perforators

Answer 13

-Ipsilateral nuclear or fascicular cranial nerve III palsy -Contralateral face, arm, leg weaknes (corticospinal tracts) -Rubral tremor (red nucleus) may develop -Ataxia (decussation of superior cerebellar peduncle) may occur

Question 14

Anterior spinal and vertebral perforators to median and paramedian medulla

Answer 14

-Ipsilateral tongue weakness (cranial nerve/nucleus XII) -Contralateral arm and leg have reduced vibration sensation and proprioception (medial lemniscus) -Contralateral arm and leg weakness (medullary pyramids)

Question 15

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

Answer 15

Internal carotid artery

Question 16

-Contralateral face and arm > leg weakness -Aphasia (dominant hemisphere) -Contralateral sensory loss -Cortical sensory loss (nondominant hemisphere) -Contralateral visual field defect -Gaze deviation ipsilateral to lesion

Answer 16

Middle cerebral artery (M1)

Question 17

-Contralateral face and arm > leg weakness -Broca’s aphasia (dominant hemisphere)

Answer 17

Middle cerebral artery, anterior division

Question 18

-Contralateral sensory loss -Wernicke’s aphasia (dominant hemisphere) -Gerstmann’s syndrome (dominant hemisphere) -Cortical sensory loss/neglect (nondominant hemisphere) -Contralateral visual field defect

Answer 18

Middle cerebral artery, posterior division

Question 19

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

Answer 19

Anterior cerebral artery

Question 20

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

Answer 20

Anterior choroidal artery

Question 21

-Contralateral sensory loss (thalamus) -Cognitive dysfunction (thalamus) -Thalamic aphasia (rarely) -Visual dysfunction as for postcommunicating segment

Answer 21

Posterior cerebral artery (precommunicating)

Question 22

-Contralateral homonymous hemianopia -Visual agnosias

Answer 22

Posterior cerebral artery (postcommunicating segment)

Question 23

-Horner’s syndrome -Ipsilateral hemiataxia -Ipsilateral palatal weakness -Hoarse voice -Decreased pain and temperature on ipsilateral face and contralateral limbs

Answer 23

Posterior inferior cerebellar artery

Question 24

-Ipsilateral deafness -Ipsilaeral facial weakness (lower motor neuron) -Ipsilateral hemiataxia -Contralateral sensory loss in limbs

Answer 24

Anterior inferior cerebellar artery

Question 25

-Ipsilateral ataxia -Decreased sensation contralaterally -Diplopia

Answer 25

Superior cerebellar artery

Question 26

-Contralateral limb weakness if unilateral or quadriparesis if bilateral -Hemiataxia may develop (crossing pontocerebellar fibers) -Cranial nerve/nuclear VI and VII palsies Internuclear ophthalmoplegia

Answer 26

Basilar perforators, median and paramedian pontine perforators

Question 27

-Ipsilateral nuclear or fascicular cranial nerve III palsy -Contralateral face, arm, leg weaknes (corticospinal tracts) -Rubral tremor (red nucleus) may develop -Ataxia (decussation of superior cerebellar peduncle) may occur

Answer 27

Midbrain basilar, posterior cerebral artery perforators

Question 28

-Ipsilateral tongue weakness (cranial nerve/nucleus XII) -Contralateral arm and leg have reduced vibration sensation and proprioception (medial lemniscus) -Contralateral arm and leg weakness (medullary pyramids)

Answer 28

Anterior spinal and vertebral perforators to median and paramedian medulla