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73 Cards in this Set
- Front
- Back
what artery joins the two anterior cerebral arteries in the circle of willis? |
AComm |
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what artery joins the anterior and the posterior circulation in the circle of willis? |
PComm |
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supply of the posterior circulation |
vertebral arteries, which join together to form the basilar artery |
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what does the ICA divide into? |
the MCA and ACA |
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what is amaurosis fugax? |
it's a TIA of the opthalmic branch of the internal carotid. means you have a RETINAL EMBOLI |
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next step after amurosis fugax |
indicates carotid artery dz, so do an u/s |
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what does wernicke's aphasia usually come with? |
right homon hemianops & occlusion of POSTERIOR* branch of MCA |
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what does Brocas usually come with? |
hemiplegia |
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what is anosognosia |
denial of illness |
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what is asomatosognosia |
denial of one part of your body |
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who has anasognosia/asomatosognosia? |
people with Right MCA stroke (Right parietal lobe) non dominant |
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why is ACA stroke not as common? |
because of anastomosis from AComm |
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both ACA and MCA stroke have hemiparesis/sensory loss, how do they differ? |
ACA is mostly LEG---can extend to face/arm if the lesion is PROXIMAL* and extends to the medial lenticulostriate artery |
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what distinguishes ACA stroke from MCA? |
ACA also has: URINARY INCONTINENCE**** |
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what are some features of ACA that are especially common if the stroke was BILATERAL? |
-Abulia: slow, apathetic -Frontal lobe release signs!!!!* |
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what all does the anterior chroidal artery supply? |
-posterior limb of internal capsule -globus pallidus -optic tract |
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why do you have homon heminap with MCA? |
optic radiations |
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why do you have homon heminop with Ant Choroidal? |
optic tract |
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What causes contra hemiplegia/sensory with MCA, ACA, Ant Choroidal? |
-MCA: precentral/postcentral gyrus -ACA: paracentral lobule -Ant Choroi: post limb |
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if the MCA occlusion is DISTAL to the lenticulostraite branches which supply the internal capsule, how will the hemiplegia look? |
FACE/ARM > LEG (otherwise all the same) |
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involvement of the middle frontal gyrus, saccadic gaze centers in MCA stroke does what? |
makes the eyes look AWAY from hemiplegia |
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where is wernicke's area? |
post superior temporal gyrus ----extends to parietal lobe |
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where is brocas |
inferior frontal lobe |
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where is gerstmann's |
angular/supramarginal gyrus |
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most common vertebral artery stroke |
PICA: usually from trauma/chiropractor that causes dissection of that artery |
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medial medullary syndrome: Ant Spinal artery |
-contra hemiplegia -contra V/P -IPS XII (tongue points AWAY from hemiplegia) |
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what is SPARED in medial medullary syndrome? |
FACE IS OK!!!! not paralyzed!!! |
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what is the only CONTRALATERAL finding in lateral medullary syndrome (PICA)? |
Contra pain/temp of ARM* and LEG* |
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pain and temperature is decresed in IPSILATERAL*** FACE in PICA d/t involvement of what tract? |
trigeminal |
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Ipsilateral findings in PICA |
-face pain/temp -horner's (descending sympathetics) -limb ataxia (inf cerebellar peduncle) |
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what are all the "weird" things with PICA |
-- Hoarseness, dysphagia, hiccups, decreased gag reflex (nucleus ambiguus) - Nystagmus, vertigo, nausea, vomiting (vestibular nuclei) |
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how is AICA occlusion like PICA? |
-both have IPS facial pain/temp loss and IPS limb ataxia -both have CONTRA pain/temp body loss
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how is AICA different? |
-IPS hearing/tinnitus (cochlear/labrynth) -IPS facial PARALYSIS*** |
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why is there ips limb ataxia in PICA, AICA? |
-PICA: inferior cerebellar peduncle -AICA: middle cerebellar peduncle |
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what does SCA occlusion present with? ALL FINDINGS IPSILATERAL**** |
-ataxia -intention tremor*** & choreiform dyskinesia***
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why does SCA have intention tremor/choreiform? |
dentate nucleus/superior cerebellar peduncle |
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what else could SCA present with |
could also have hearing loss & contra pain and temp loss but look for TREMOR/CHORIEFORM to distinguish!! |
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"locked in" |
basilar artery stroke |
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ipsilateral 6/7 palsy with contra hemiplegia |
basilar artery stroke from lateral pons |
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cluster /crossed findings |
basilar artery |
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proximal PCA occlusion: Weber's syndrome |
-CONTRA hemiparesis (cerebral peduncle) -IPS CNIII palsy -possibly contra sensory from thalamogenticulate branch |
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distal PCA occlusion: |
-CONTRA homon heminop (often with MACULAR SPARING**) -memory issues (temporal lobe) -alexia without agraphia*** (if PCA is in DOMINANT hemisphere) |
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what is alexia without agraphia |
can write but not read (occipital lobe & splenium of corpus callosum) |
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patient can't read because that involves Wernicke's and the right wernicke isn't getting any input from the broken left wernicke |
but can write ok becacause still has Right occipital lobe |
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what happens in a BILATERAL PCA stroke? |
cortical blindness, sometimes even Antons*** |
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Anton syndrome |
patient denies loss of vision |
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bilateral mesio-temporal stroke from B/L PCA OCCLUSION*** |
PROSOPAGNOSIA!!! |
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small vessel (lacunar) strokes |
subcortical areas, deep penetrating |
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lacunar strokes |
<2cm, HTN&DM |
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pure motor stroke: post limb of internal capsule |
contra FACE/ARM/LEG that's it! d/t lenticulostriate branch of MCA |
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pure sensory stroke: VPM/VPL or sensory fibers of post limb internal capsule |
contra FACE/ARM/LEG d/t thalamogenticulate branch of PCA |
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patient is ataxic and has weakness on one side of the body, nothing else going on |
ataxic-hemiparesis stroke d/t post limb of internal capsule/basis pontis/CST/ascending cerebellar pathways |
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what is sometimes spared in ataxic-hemiparesis stroke |
face |
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hemiballismus |
contralateral SUBTHALAMIC NUCLEUS*** |
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sudden onset dysarthria & hand clumsiness, where is the stroke? |
upper basis pontis, or (cerebral peduncle of midbrain or internal capsule) |
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what happens to patients who have had MULTIPLE SUBCORTICAL (LACUNAR) strokes |
-often get PROFOUND pseudobulbar palsy along with emotional lability & cognitive defects |
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how are charcot-bouchard aneurysms different from saccular berry aneurysms? |
charcot go into the PARENCHYMA of the brain (from HTN) |
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how do people with charcot-bouchard aneurysms typically present |
-focal findings -ICP (vomiting, etc) |
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putaminal hemmorhage |
contra hemiplegia (sometimes sensory loss too if adjacent internal capsule is affected) (sometimes homon hemi if adjacent optic radiations are affected) |
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thalamaic hemorrhage |
sensory>motor |
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why is there often paralysis of vertical eye movements with thalamic hemorrhage? |
it sits just above the midbrain |
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patient was nauseous etc, then all of a sudden has LOC. has PINPOINT PUPILS on exam |
pontine hemorrhage*** |
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why pinpoint pupils on pontine hemorrhage? |
descending sympathetics |
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occipital headache, stiff neck, N/V, can't walk & IPS ataxia/nystagmus |
occipital hemorhage |
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what causes SAH? |
developmental defects in elastic/media of the vessel such that the intima is bulging out through the adventitia uncovered |
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risk factors for SAH |
smoking, HTN, PCKD**** |
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when does a SAH have greatest risk of rupture? |
>10mm |
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most common location of SAH? |
bifurcations*** of circle of willis, usually anterior |
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aneurysms cause NO SYMPTOMS until they rupture |
sometimes headache/vomiting |
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some findings of a SAH on neuro exam |
-subhyloid retinal hemorrhages -neck pain worse with flexion (stretching of meninges) -no focal findings (maybe CNIII palsy from PCOmm rupture) |
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if no bleeding on CT, what next? |
LP |
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how to confirm location of anuerysm |
angio, then clip |
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most common complications after hemorhage |
vasospams/rebleeding |