Cole 6

Front 1

what artery joins the two anterior cerebral arteries in the circle of willis?

Back 1

AComm

Front 2

what artery joins the anterior and the posterior circulation in the circle of willis?

Back 2

PComm

Front 3

supply of the posterior circulation

Back 3

vertebral arteries, which join together to form the basilar artery

Front 4

what does the ICA divide into?

Back 4

the MCA and ACA

Front 5

what is amaurosis fugax?

Back 5

it's a TIA of the opthalmic branch of the internal carotid. means you have a RETINAL EMBOLI

Front 6

next step after amurosis fugax

Back 6

indicates carotid artery dz, so do an u/s

Front 7

what does wernicke's aphasia usually come with?

Back 7

right homon hemianops & occlusion of POSTERIOR* branch of MCA

Front 8

what does Brocas usually come with?

Back 8

hemiplegia

Front 9

what is anosognosia

Back 9

denial of illness

Front 10

what is asomatosognosia

Back 10

denial of one part of your body

Front 11

who has anasognosia/asomatosognosia?

Back 11

people with Right MCA stroke (Right parietal lobe) non dominant

Front 12

why is ACA stroke not as common?

Back 12

because of anastomosis from AComm

Front 13

both ACA and MCA stroke have hemiparesis/sensory loss, how do they differ?

Back 13

ACA is mostly LEG---can extend to face/arm if the lesion is PROXIMAL* and extends to the medial lenticulostriate artery

Front 14

what distinguishes ACA stroke from MCA?

Back 14

ACA also has: URINARY INCONTINENCE****

Front 15

what are some features of ACA that are especially common if the stroke was BILATERAL?

Back 15

-Abulia: slow, apathetic

-Frontal lobe release signs!!!!*

Front 16

what all does the anterior chroidal artery supply?

Back 16

-posterior limb of internal capsule

-globus pallidus

-optic tract

Front 17

why do you have homon heminap with MCA?

Back 17

optic radiations

Front 18

why do you have homon heminop with Ant Choroidal?

Back 18

optic tract

Front 19

What causes contra hemiplegia/sensory with MCA, ACA, Ant Choroidal?

Back 19

-MCA: precentral/postcentral gyrus

-ACA: paracentral lobule

-Ant Choroi: post limb

Front 20

if the MCA occlusion is DISTAL to the lenticulostraite branches which supply the internal capsule, how will the hemiplegia look?

Back 20

FACE/ARM > LEG (otherwise all the same)

Front 21

involvement of the middle frontal gyrus, saccadic gaze centers in MCA stroke does what?

Back 21

makes the eyes look AWAY from hemiplegia

Front 22

where is wernicke's area?

Back 22

post superior temporal gyrus ----extends to parietal lobe

Front 23

where is brocas

Back 23

inferior frontal lobe

Front 24

where is gerstmann's

Back 24

angular/supramarginal gyrus

Front 25

most common vertebral artery stroke

Back 25

PICA: usually from trauma/chiropractor that causes dissection of that artery

Front 26

medial medullary syndrome: Ant Spinal artery

Back 26

-contra hemiplegia

-contra V/P

-IPS XII (tongue points AWAY from hemiplegia)

Front 27

what is SPARED in medial medullary syndrome?

Back 27

FACE IS OK!!!! not paralyzed!!!

Front 28

what is the only CONTRALATERAL finding in lateral medullary syndrome (PICA)?

Back 28

Contra pain/temp of ARM* and LEG*

Front 29

pain and temperature is decresed in IPSILATERAL*** FACE in PICA d/t involvement of what tract?

Back 29

trigeminal

Front 30

Ipsilateral findings in PICA

Back 30

-face pain/temp

-horner's (descending sympathetics)

-limb ataxia (inf cerebellar peduncle)

Front 31

what are all the "weird" things with PICA

Back 31

-- Hoarseness, dysphagia, hiccups, decreased gag reflex (nucleus ambiguus)

- Nystagmus, vertigo, nausea, vomiting (vestibular nuclei)

Front 32

how is AICA occlusion like PICA?

Back 32

-both have IPS facial pain/temp loss and IPS limb ataxia

-both have CONTRA pain/temp body loss

Front 33

how is AICA different?

Back 33

-IPS hearing/tinnitus (cochlear/labrynth)

-IPS facial PARALYSIS***

Front 34

why is there ips limb ataxia in PICA, AICA?

Back 34

-PICA: inferior cerebellar peduncle

-AICA: middle cerebellar peduncle

Front 35

what does SCA occlusion present with? ALL FINDINGS IPSILATERAL****

Back 35

-ataxia

-intention tremor*** & choreiform dyskinesia***

Front 36

why does SCA have intention tremor/choreiform?

Back 36

dentate nucleus/superior cerebellar peduncle

Front 37

what else could SCA present with

Back 37

could also have hearing loss & contra pain and temp loss but look for TREMOR/CHORIEFORM to distinguish!!

Front 38

"locked in"

Back 38

basilar artery stroke

Front 39

ipsilateral 6/7 palsy with contra hemiplegia

Back 39

basilar artery stroke from lateral pons

Front 40

cluster /crossed findings

Back 40

basilar artery

Front 41

proximal PCA occlusion: Weber's syndrome

Back 41

-CONTRA hemiparesis (cerebral peduncle)

-IPS CNIII palsy

-possibly contra sensory from thalamogenticulate branch

Front 42

distal PCA occlusion:

Back 42

-CONTRA homon heminop (often with MACULAR SPARING**)

-memory issues (temporal lobe)

-alexia without agraphia*** (if PCA is in DOMINANT hemisphere)

Front 43

what is alexia without agraphia

Back 43

can write but not read (occipital lobe & splenium of corpus callosum)

Front 44

patient can't read because that involves Wernicke's and the right wernicke isn't getting any input from the broken left wernicke

Back 44

but can write ok becacause still has Right occipital lobe

Front 45

what happens in a BILATERAL PCA stroke?

Back 45

cortical blindness, sometimes even Antons***

Front 46

Anton syndrome

Back 46

patient denies loss of vision

Front 47

bilateral mesio-temporal stroke from B/L PCA OCCLUSION***

Back 47

PROSOPAGNOSIA!!!

Front 48

small vessel (lacunar) strokes

Back 48

subcortical areas, deep penetrating

Front 49

lacunar strokes

Back 49

<2cm, HTN&DM

Front 50

pure motor stroke: post limb of internal capsule

Back 50

contra FACE/ARM/LEG that's it! d/t lenticulostriate branch of MCA

Front 51

pure sensory stroke: VPM/VPL or sensory fibers of post limb internal capsule

Back 51

contra FACE/ARM/LEG d/t thalamogenticulate branch of PCA

Front 52

patient is ataxic and has weakness on one side of the body, nothing else going on

Back 52

ataxic-hemiparesis stroke d/t post limb of internal capsule/basis pontis/CST/ascending cerebellar pathways

Front 53

what is sometimes spared in ataxic-hemiparesis stroke

Back 53

face

Front 54

hemiballismus

Back 54

contralateral SUBTHALAMIC NUCLEUS***

Front 55

sudden onset dysarthria & hand clumsiness, where is the stroke?

Back 55

upper basis pontis, or (cerebral peduncle of midbrain or internal capsule)

Front 56

what happens to patients who have had MULTIPLE SUBCORTICAL (LACUNAR) strokes

Back 56

-often get PROFOUND pseudobulbar palsy along with emotional lability & cognitive defects

Front 57

how are charcot-bouchard aneurysms different from saccular berry aneurysms?

Back 57

charcot go into the PARENCHYMA of the brain (from HTN)

Front 58

how do people with charcot-bouchard aneurysms typically present

Back 58

-focal findings

-ICP (vomiting, etc)

Front 59

putaminal hemmorhage

Back 59

contra hemiplegia (sometimes sensory loss too if adjacent internal capsule is affected) (sometimes homon hemi if adjacent optic radiations are affected)

Front 60

thalamaic hemorrhage

Back 60

sensory>motor

Front 61

why is there often paralysis of vertical eye movements with thalamic hemorrhage?

Back 61

it sits just above the midbrain

Front 62

patient was nauseous etc, then all of a sudden has LOC. has PINPOINT PUPILS on exam

Back 62

pontine hemorrhage***

Front 63

why pinpoint pupils on pontine hemorrhage?

Back 63

descending sympathetics

Front 64

occipital headache, stiff neck, N/V, can't walk & IPS ataxia/nystagmus

Back 64

occipital hemorhage

Front 65

what causes SAH?

Back 65

developmental defects in elastic/media of the vessel such that the intima is bulging out through the adventitia uncovered

Front 66

risk factors for SAH

Back 66

smoking, HTN, PCKD****

Front 67

when does a SAH have greatest risk of rupture?

Back 67

>10mm

Front 68

most common location of SAH?

Back 68

bifurcations*** of circle of willis, usually anterior

Front 69

aneurysms cause NO SYMPTOMS until they rupture

Back 69

sometimes headache/vomiting

Front 70

some findings of a SAH on neuro exam

Back 70

-subhyloid retinal hemorrhages

-neck pain worse with flexion (stretching of meninges)

-no focal findings (maybe CNIII palsy from PCOmm rupture)

Front 71

if no bleeding on CT, what next?

Back 71

LP

Front 72

how to confirm location of anuerysm

Back 72

angio, then clip

Front 73

most common complications after hemorhage

Back 73

vasospams/rebleeding