Neuro - Anat & Phys (Effects of Strokes & Aneurysms) Flashcards Preview

FA - Neurology > Neuro - Anat & Phys (Effects of Strokes & Aneurysms) > Flashcards

Flashcards in Neuro - Anat & Phys (Effects of Strokes & Aneurysms) Deck (46):
1

What are 3 main vessels in the anterior circulation of the brain?

(1) MCA (Middle cerebral artery) (2) ACA (Anterior cerebral artery) (3) Lenticulo-striate artery

2

What are 4 major areas of the brain in the MCA territory?

(1) Motor cortex - upper limb and face (2) Sensory cortex - upper limb and face (3) Temporal lobe (Wernicke area) (4) Frontal lobe (Broca area)

3

What symptoms are caused by a motor cortex (upper limb and face) lesion? To which artery would such a lesion apply?

Contralateral paralysis - upper limb and face; MCA

4

What symptoms are caused by a sensory cortex (upper limb and face) lesion? To which artery would such a lesion apply?

Contralateral loss of sensation - upper limbs, and face; MCA

5

What symptoms are caused by a Temporal lobe (Wernicke area) or Frontal lobe (Broca area) lesion? To which artery would such a lesion apply?

Aphasia if in dominant (usually) left hemisphere. Hemineglect if lesion affects nondominant (usually right) side; MCA

6

What are 2 major areas of the brain in the ACA territory?

(1) Motor cortex - lower limb (2) Sensory cortex - lower limb

7

What symptoms are caused by a motor cortex (lower limb) lesion? To which artery would such a lesion apply?

Contralateral paralysis - lower limb; ACA

8

What symptoms are caused by a sensory cortex (lower limb) lesion? To which artery would such a lesion apply?

Contralateral loss of sensation - lower limb; ACA

9

What are 2 major areas of the brain in the Lenticulo-striate artery territory?

(1) Striatum (2) Internal capsule

10

What symptoms are caused by a striatum/internal capsule lesion? To which artery would such a lesion apply?

Contralateral hemiparesis/hemiplegia; Lenticulo-striate artery

11

Which artery is a common location of lacunar infarcts? To what clinical condition are lacunar infarcts secondary?

Lenticulo-striate artery; Common location of lacunar infarcts, secondary to unmanaged hypertension

12

What are 5 main vessels in the posterior circulation?

(1) ASA (Anterior spinal artery) (2) PICA (Posterior inferior cerebellar artery) (3) AICA (Anterior inferior cerebellar artery) (4) PCA (Posterior cerebral artery) (5) Basilar artery

13

What are 3 major areas of the brain in the ASA territory?

(1) Lateral corticospinal tract (2) Medial lemniscus (3) Caudal medulla - hypoglossal nerve

14

What symptoms are caused by a lateral corticospinal tract lesion? To which artery would such a lesion apply?

Contralateral hemiparesis - upper and lower limbs; ASA

15

What symptoms are caused by a medial lemniscus lesion? To which artery would such a lesion apply?

Decreased contralateral proprioception; ASA

16

What symptoms are caused by a caudal medulla (hypoglossal nerve) lesion? To which artery would such a lesion apply?

Ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally); ASA

17

Is stroke associated with ASA commonly bilateral or unilateral?

Stroke commonly bilateral

18

What infarct causes medial medullary syndrome? What are its associated symptoms, and why?

Caused by infarct of paramedian branches of ASA and vertebral arteries; Contralateral hemiparesis - upper and lower limbs (Corticospinal tract), Decreased contralateral proprioception (Medial lemniscus), Ipsilateral hypoglossal dysfunction - tongue deviates ipsilaterally (Caudal medulla - hypoglossal nerve)

19

What is the major area of the brain in the PICA territory? What are 6 specific brain structures contained in this area?

Lateral medulla - (1) Vestibular nuclei (2) Lateral spinothalamic tract (3) Spinal trigeminal nucleus (4) Nucleus ambiguus (5) Sympathetic fibers (6) Inferior cerebellar peduncle

20

What symptoms are caused by a lateral medulla lesion, and why? What is the name associated with this collection of symptoms? To which artery would such a lesion apply?

Vomiting, vertigo, nystagmus (vestibular nuclei); Decreased pain and temperature sensation from ipsilateral face (spinal trigeminal nucleus) and contralateral body (lateral spinothalamic tract); Dysphagia, hoarseness, decreased gag reflex (nucleus ambiguus); ipsilateral Horner syndrome (sympathetic fibers); ataxia, dysmetria (inferior cerebellar peduncle); Lateral medullary (Wallenbery) syndrome; PICA

21

What brain structure's effects are specific to PICA lesions?

Nucleus ambiguus effects are specific to PICA lesions; Think: "Don't pick a (PICA) horse (hoarseness) that can't eat (dysphagia)."

22

What are 2 major areas of the brain in the AICA territory? What are important structures contained within each of these areas, if any?

(1) Lateral pons - cranial nerve nuclei; vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers (2) Middle and inferior cerebellar peduncles

23

What symptoms are caused by a lateral pons lesion, and why? What is the name associated with this collection of symptoms? To which artery would such a lesion apply?

Vomiting, vertigo, nystagmus (vestibular nuclei); Paralysis of face, decreased lacrimation, salivation, decreased taste from anterior 2/3 of tongue, decreased corneal reflex (facial nucleus); Ipsilateral loss of pain and temperature of face, contralateral loss of pain and temperature of body (spinal trigeminal nucleus); Ipsilateral decreased hearing (cochlear nuclei); Ipsilateral Horner syndrome (sympathetic fibers); Lateral pontine syndrome; AICA

24

What brain structure's effects are specific to AICA lesions?

Facial nucleus effects are specific to AICA lesions; "Think: Facial droop means AICA's pooped"

25

What symptoms are caused by a lesion to middle and inferior cerebellar peduncles? To which artery would such a lesion apply?

Ataxia, dysmetria; AICA

26

What major area(s) of the brain is (are) in the PCA territory?

Occipital cortex, visual cortex

27

What symptoms are caused by a lesion to the occipital cortex/visual cortex? To which artery would such a lesion apply?

Contralateral hemianopia with macular sparing

28

What major 7 areas of the brain are in the basilar artery territory?

(1) Pons (2) Medulla (3) Lower midbrain (4) Corticospinal and (5) Corticobulbar tracts (6) Ocular cranial nerve nuclei (7) Paramedian pontine reticular formation

29

Again, what 7 areas of the brain are in the basilar artery territory? What symptoms are caused by a basilar artery lesion? What is the collective name for these symptoms?

Pons, medullar, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, paremedian pontine reticular formation; Preserved consciousness and blinking, quadriplegia, loss of voluntary facial, mouth, and tongue movements; "Locked-in syndrome"

30

What are the 2 communicating arteries? What kind of lesions are typically seen in these arteries?

(1) ACom (anterior communicating) (2) PCom (posterior communicating); Lesions are typically aneurysms, not strokes

31

What is the most common lesion in ACom? What are 2 complications associated with this lesion?

Most common lesion is aneurysm; (1) Can lead to stroke (2) Saccular (berry) aneurysm can impinge cranial nerves

32

What symptom(s) is (are) associated with an ACom lesion?

Visual field defects

33

What lesion is common in PCom?

Common site of saccular aneurysm

34

What symptom(s) is (are) associated with a PCom lesion?

CN III palsy - eye is "down and out" with ptosis and pupil dilation

35

In general, what is an aneurysm, and what causes it?

In general, an abnormal dilation of artery due to weakening of vessel wall

36

Where does a Berry aneurysm occur?

Occurs at the bifurcations in the circle of Willis

37

What is the most common site of a Berry aneurysm?

Most common site is junction of the anterior communicating artery and anterior cerebral artery

38

What is the most common complication of a Berry aneurysm? What are 2 consequences that such a complication may have?

Rupture (most common complication) leads to subarachnoid hemorrhage ("worst headache of life") or hemorrhagic stroke

39

Besides rupture, what is another complication that may result from a Berry aneurysm, and what causes it?

Can also cause bitemporal hemianopia via compression of optic chiasm

40

What 3 diseases/conditions associated with Berry aneurysms?

Associated with ADPKD, Ehlers-Danlos syndrome, and Marfan syndrome

41

What are 4 risk factors associated with Berry aneurysms?

Other risk factors: advanced age, hypertension, smoking, race (increased risk in blacks)

42

With what condition is Charcot-Bouchard microaneurysm associated?

Associated with chronic hypertension

43

In general, what structures in the brain does Charcot-Bouchard microaneurysm affect? Give 2 specific examples.

Affects small vessels (e.g., in basal ganglia, thalamus)

44

What is Central post-stroke pain syndrome, and what causes it?

Neuropathic pain due to thalamic lesions

45

What are the initial versus later symptoms of Central post-stroke pain syndrome, and what time frame typically separates them?

Initial sensation of numbness and tingling followed in weeks to months by allodynia (ordinary painless stimuli cause pain) and dysaesthesia.

46

In what percentage of stroke patients does Central post-stroke pain syndrome occur?

Occurs in 10% of stroke patients

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