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Questions and Answers
What is a common consequence of occlusion of the left subclavian artery proximal to the origin of the left vertebral artery?
Which symptom is commonly associated with Wallenberg’s syndrome?
What is the relationship between subclavian steal and treatment options?
What is a key indicator of the prognosis in medial medullary infarction?
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Which group of symptoms is most commonly associated with Wallenberg’s syndrome?
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Which statement is NOT true regarding the outcomes of Wallenberg’s syndrome?
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What is a common misconception about infarct of the medial medulla?
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What vascular condition is most frequently related to medial medullary infarction?
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Which of the following is a characteristic symptom of the syndrome of the anterior choroidal artery (AChA)?
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What is true regarding limb-shaking transient ischemic attacks (TIAs)?
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Which statement accurately describes prosopagnosia?
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What is a hallmark feature of pseudobulbar affect?
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How is intravascular lymphoma typically characterized?
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Which of the following correctly describes the visual field defects associated with anterior choroidal artery syndrome?
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Which statement about limb-shaking TIAs is accurate?
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Which of the following is incorrect regarding pseudobulbar affect?
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Study Notes
Subclavian Steal Syndrome
- Occurs when the subclavian artery is narrowed or blocked before the origin of the left common carotid artery.
- Can cause blood pressure asymmetry in the arms.
- Symptoms of brainstem ischemia in most patients.
- Can be treated with a subclavian stent or surgically with axillo-axillary or carotid-subclavian bypass.
Occlusion of the Left Subclavian Artery
- Occlusion proximal to the origin of the left vertebral artery can reduce flow in the left vertebral artery.
Wallenberg's (Lateral Medullary) Syndrome
- Often associated with lesions in the posterior inferior cerebellar artery (PICA) or vertebral artery (VA).
- Symptoms may include skew deviation of the eyes, forced gaze deviation, dysphagia, hoarseness, hiccups, and headache.
- Often results in poor functional outcome, high risk of aspiration pneumonia, poststroke pain, and drooling.
Infarction of the Medial Medulla
- Post-stroke pain is rare.
- Most commonly caused by vertebral artery atherosclerosis with atheromatous branch occlusion.
- Generally has a favorable prognosis for motor recovery.
- Vertigo is uncommon.
- Diplopia does not occur.
Anterior Choroidal Artery (AChA) Syndrome
- A well-defined constellation of symptoms: hemiparesis without hemisensory loss, homonymous upper and lower field defect sparing the horizontal meridian, and absence of higher cortical function deficit.
- Can affect the thalamus and brainstem.
- Produces symptoms in the territories of both anterior and posterior circulation.
- Most often has a gradual, stuttering onset.
- Visual field defects can occur due to involvement of the visual cortex.
Limb-Shaking Transient Ischemic Attacks (TIAs)
- Most often caused by platelet emboli.
- Platelet inhibition is the preventative treatment.
- May be induced by exercise.
- Not associated with moyamoya disease.
Prosopagnosia
- A disturbance in face recognition.
- Thought to be related to damage to the right fusiform gyrus.
- Most often associated with a right hemianopia.
- Can be caused by stroke, but may also have other causes.
Pseudobulbar Affect
- Related to loss of cortico-pontine-cerebellar circuits.
- Caused by excess glutamatergic transmission and decreased serotonergic transmission.
- Includes inappropriate outbursts of laughing or crying, along with spastic dysarthria.
- Most often occurs in amyotrophic lateral sclerosis (ALS) and stroke, but also with multiple sclerosis (MS) and Parkinson's disease.
Intravascular Lymphoma
- CNS and skin are the most common areas of involvement.
- Usually derived from T cells that have invaded vessels from the parenchyma.
- Systemic, nonneurological symptoms may present early.
- MRI may show a "butterfly lesion" crossing the corpus callosum.
- Prognosis is generally favorable.
Secondary Stroke Prevention Guidelines
- Target blood pressure levels for control should be lower than previously recommended.
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Description
This quiz covers key concepts related to Subclavian Steal Syndrome, occlusion of the left subclavian artery, Wallenberg's syndrome, and infarction of the medial medulla. Explore the symptoms, causes, and treatment options associated with these conditions. Test your knowledge on vascular disorders and their implications for brain health.
