Stroke

Question 1

Function of the

Frontal Lobe

Answer 1

Executive Functions
Frontal Eye Field
Motor Area
Speech/ Broca Area
Bowel/ Bladder Function

Question 2

Function of the

Parietal Lobe

Answer 2

Tactile Sensation
Pain Localization
Spatial Awareness

Question 3

Function of the

Occipital Lobe

Answer 3

Vision

Question 4

Function of

Temporal Lobe

Answer 4

Olfaction
Memory
Language comprehension/ Wernicke’s Area
Vision

Question 5

Blood vessels supplying the

Frontal Lobe

Answer 5

MCA and ACA

Question 6

Blood vessels supplying the

Parietal Lobe

Answer 6

MCA and ACA

Question 7

Vessels supplying the

Temporal Lobe

Answer 7

MCA and PCA

Question 8

Explain the syndrome of neglect and the location of a lesion that causes it

Answer 8

Neglect is typically caused by lesions in the posterior parietal lobe. It is characterized by deficits in spatial awareness and anosognosia. The patient disregards the left side of their body and the world. The patient may attribute parts of their left body to another person and is not aware of their deficit.

Question 9

How does infarct of the frontal eye fields affect lateral gaze of the eyes?

Answer 9

Activation of the FEF in one hemisphere cause lateral gaze in the opposite direction. The circuit involves the contralateral PPRF, CN VI, and CN III. Infarct of the RT FEF causes sustained gaze to the RT.

Question 10

Where are the cortical locations involved in Broca and Wernicke areas.

Answer 10

Broca area is in the inferior frontal lobe; Wernicke area is in the posterior, superior temporal lobe.

Question 11

How are the deficits caused by a proximal MCA infarct different from the deficits caused by a distal MCA infarct.

Answer 11

A proximal MCA infarct affects branches that supply deep areas of the hemispheres via the lenticulostriate arteries. These branches supply the internal capsule that is the highway for motor and sensory information for the entire contralateral body. Thus an internal capsule lesion can cause weakness of the entire body on the contralateral side. In contrast, a distal infarct of the MCA supplies motor and sensory areas of the upper body and face, but not the lower limb.

Question 12

What is meant by language-dominant hemisphere?

Answer 12

Language areas involved in speech and comprehension reside in the left hemisphere for most people. Homologous areas in the right hemisphere are involved with other aspects of language such as tonal qualities, rhythm, prosody, song. Most right-handers have language areas localized to the left hemisphere. Most left-handers also have language localized to the left hemisphere, but a larger proportion (30%) have language localized to the right hemisphere.

Question 13

How can a cortical stroke be distinguished from a CN VII lesion in terms of facial deficits?

Answer 13

Cortical (UMN) lesions cause weakness of only the lower face on the opposite side. CN VII lesions cause weakness of the entire face on one (ipsilateral) side.

Question 14

How does the cause of stroke differ for cortical vs subcortical strokes?

Answer 14

Cortical areas are supplied by larger vessels that are affected by thrombosis and emboli. Subcortical areas are supplied by smaller vessels that are affected by hypertension and diabetes that lead to lipohyalinosis.

Question 15

What is lipohyalinosis, where does it occur in brain vessels, what are its risk factors?

Answer 15

Lipohyalinosis is a pathological process that results in damage to endothelium of small brain vessels. It occurs in the small penetrating vessels that supply deep subcortical areas like the internal capsule and basal ganglia. It results in lacunar infarcts. Risk factors are hypertension, diabetes, dyslipidemia, smoking, lack of exercise, ageing.

Question 16

What are the major locations affected by subcortical strokes?

Answer 16

Cerebral hemisphere: internal capsule, basal ganglia, thalamus
Brainstem
Cerebellum

Question 17

What are the defining symptoms for brainstem strokes?

Answer 17

CN symptoms (except CN I, II, VII lower face, XI)
Also: Motor/sensory deficits for face/arm/leg (except for internal capsule)
Vertigo – likely but can also result from cortical stroke
Cerebellar deficits – possible but can also result from internal capsule lesions

Question 18

What are the symptoms of cerebellar stroke?

Answer 18

Vestibular (nausea/vomiting, nystagmus, falling, vertigo), gait ataxia, limb ataxia

Question 19

What are the symptoms of cortical stroke?

Answer 19

• Cognitive deficits
• Language deficits - aphasias
• Motor/sensory deficits for face/arm without not leg
• Motor/sensory deficits for leg without face/arm
• Sustained eye deviation to one side
• Visual hemi/quadrant- anopsia
• Absence of CN symptoms except lower face deficit without upper face

Question 20

What are the symptoms of subcortical stroke?

Answer 20

• Motor/sensory deficits for face, arm and leg
• CN deficits (except I, II, XI, CN VII lower face)
• Pure motor symptoms (face, arm, leg)
• Pure sensory symptoms (tactile/pain body and face)
• Cerebellar deficits
• Lack of cognitive deficits

Question 21

What is the major difference between cortical and subcortical stroke?

Answer 21

Subcortical strokes lack cognitive deficits and include CN deficits

Question 22

What regions of the midbrain are impacted by PCA lesions

Answer 22

ML
VTT
ALS
Hypothalamic Tract
Sup Cerebellar Peduncle
CST/ CBT
Frontopontine
CNIII

Question 23

What Midbrain structures are impacted by SCA lesion?

Answer 23

Vertical gaze center

Question 24

What pons structures are affected by lesions to the basilar artery?

Answer 24

ML
VTT
STGT
ALS
Hypothalamospinal Tract
Superior Cerebellar Peduncle
Middle Cerebellar Peduncle
CBT/ CST
Pontine nuclei
Horizontal Gaze Center
CN V
CN VI

Question 25

What structures of the pons are impacted by a lesion in the AICA?

Answer 25

CN VII CN VIII

Question 26

What structures in the medulla are impacted by a lesion in the ASA?

Answer 26

ML VTT CBT/ CST CN XII

Question 27

What structures of the medulla are impacted by a lesion to the PICA?

Answer 27

ALS Hypothalamospinal tract Inferior Cerebellar peduncle Vestibular Nuclei STGT Nucleus Ambiguous

Question 28

Damage to the ML in the midbrain, pons, and medulla causes

Answer 28

contralateral loss of tactile sense on the body

Question 29

Damage to the VTT in the midbrain and rostral pons causes

Answer 29

contralateral loss of tactile/ pain sense on the face

Question 30

Damage to the VTT in the caudal pons and medulla cause

Answer 30

contralateral loss of pain/temp on the face

Question 31

Damage to the ALS in the midbrain, pons, or medulla causes:

Answer 31

contralateral loss of pain/ temp on the body

Question 32

Damage to the Hypothalamospinal tract in the midbrain, pons, and medulla causes

Answer 32

Ipsilateral Horners Syndrome

Question 33

Damage to the superior cerebellar peduncle in the midbrain causes

Answer 33

Contralateral limb ataxia Truncal ataxia

Question 34

Damage to the superior cerebellar peduncle in the pons causes

Answer 34

ipsilateral limb ataxia truncal ataxia

Question 35

Damage to the CST/ CBT in the midbrain, pons, medulla causes

Answer 35

contralateral UMN deficits in the body, lower face droop, and tongue deviation

Question 36

Damage to the Nucleus Ambiguous in the medulla causes

Answer 36

Ipsilateral loss of gag reflex Dysphagia Dysarthria

Question 37

Damage to the frontopontine in the midbrain causes

Answer 37

contralateral limb ataxia

Question 38

Damage to the Vertical gaze center in the midbrain causes

Answer 38

Paralysis of vertical gaze

Question 39

Damage to CN III in the midbrain causes

Answer 39

Down and out Loss of pupillary light reflex

Question 40

Damage to the middle cerebellar peduncle in the pons causes

Answer 40

ipsilateral limb ataxia truncal ataxia

Question 41

Damage to the pontine nuclei causes

Answer 41

Contralateral limb ataxia

Question 42

Damage to the Horizontal Gaze Center in the pons causes

Answer 42

eyes turned to opposite side

Question 43

Damage to CN V in the pons causes

Answer 43

jaw deviates to same side

Question 44

Damage to CN VI in the pons causes

Answer 44

ipsilateral eye deviates medially

Question 45

Damage to CN VII in the pons causes

Answer 45

ipsilateral facial paralysis

Question 46

Damage to CN VIII in the pons causes

Answer 46

Ipsilateral deafness

Question 47

Damage to the Inferior Cerebellar Peduncle in the medulla causes

Answer 47

ipsilateral limb ataxia truncal ataxia vestibular symptoms

Question 48

Damage to CN XII in the medulla causes

Answer 48

Deviation of tongue to ipsilateral side

Question 49

Symptoms of an ASA infarct

Answer 49

* contralateral loss of tactile sense on body * contralateral loss of pain/temp on face * deviation of tongue to ipsilateral side * contralateral: UMN deficits for body, lower face droop, tongue deviation

Question 50

Symptoms of a PCA infarct

Answer 50

* contralateral loss of tactile sense on body * contralateral loss of tactile/pain sense on face * contralateral loss of pain/temp on body * ipsilateral Horner’s syndrome * contralateral limb ataxia; truncal ataxia * contralateral: UMN deficits for body, lower face droop, tongue deviation * contralateral limb ataxia * eye down and out, loss of pupillary light reflex

Question 51

Symptoms of a SCA infarct

Answer 51

* paralysis of vertical gaze

Question 52

Symptoms of a PICA infarct

Answer 52

* contralateral loss of pain/temp on body * ipsilateral Horner’s syndrome * ipsilateral limb ataxia; truncal ataxia; vestibular symptoms * vestibular symptoms (falling, vertigo, nausea, nystagmus) * ipsilateral loss of pain/temp on face * ipsilateral loss of gag reflex, dysphagia, dysarthria

Question 53

Symptoms of a Basilar artery infarct

Answer 53

* contralateral loss of tactile sense on body * contralateral loss of tactile/pain sense on face * contralateral loss of pain on face * ipsilateral loss of pain/temp on face * contralateral loss of pain/temp on body * ipsilateral Horner’s syndrome * ipsilateral limb ataxia; truncal ataxia * ipsilateral limb ataxia; truncal ataxia * contralateral: UMN deficits for body, lower face droop, tongue deviation * contralateral limb ataxia * eyes turned to opposite side * jaw deviates to same side * ipsilateral eye deviates medially

Question 54

Symptoms of an AICA infarct

Answer 54

* ipsilateral facial paralysis * ipsilateral deafness

Question 55

Symptoms of stroke of the anterior limb of the internal capsule

Answer 55

Cerebellar symptoms

Question 56

Symptoms of stroke of the posterior limb of the internal capsule

Answer 56

Pure UMN motor symptoms involving face, arm, trunk, leg

Question 57

Symptoms of stroke of the Diencephalon (VPL/ VPM) Subthalamic nucleus)

Answer 57

* Pure sensory (tactile, pain) symptoms for body and face

Question 58

Symptoms of stroke of the Diencephalon (Subthalamic nucleus)

Answer 58

* Hemiballismus

Question 59

Symptoms of stroke of the optic radiations (white matter)

Answer 59

* hemi- or quadrant- anopsia depending on position and depth

Question 60

Symptoms of stroke of the superior long/ arcuate fascilculus

Answer 60

Conduction aphasia

Question 61

Vessel that supplies anterior limb of the internal capsule

Answer 61

ACA

Question 62

Vessel that supplies the posterior limb of the internal capsule

Answer 62

MCA A Ch A

Question 63

Vessel that supplies the diencephalon (VPL/ VPM/ Subthalamic nucleus)

Answer 63

PCA

Question 64

Vessel that supplies the optic radiations

Answer 64

MCA PCA

Question 65

Vessel that supplies the Arcuate fasciculus

Answer 65

MCA

Question 66

Vessel infarcted that causes LMN deficits for the eyes

Answer 66

PCA

Question 67

Vessel infarcted that causes LMN deficits for the jaw

Answer 67

Basilar

Question 68

Vessel infarcted that causes LMN deficits for the face

Answer 68

AICA

Question 69

Vessel infarcted that causes LMN deficits for the pharynx/ larynx

Answer 69

PICA

Question 70

Vessel infarcted that causes LMN deficits for the tongue

Answer 70

ASA