Cerebrovascular Accident and Blood Supply Quiz

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Questions and Answers

Which cranial nerves are affected in Wallenberg syndrome?

  • CN 5, 9, 10, 12
  • CN 8
  • CN 5, 8, 9, 10, 11 (correct)
  • CN 5, 7, 8

A lesion affecting the medial lemniscus results in which of the following sensory deficits?

  • Contralateral loss of proprioception, two-point discrimination, and vibration (correct)
  • Ipsilateral loss of proprioception, two-point discrimination, and vibration
  • Contralateral loss of pain and temperature sensation
  • Ipsilateral loss of pain and temperature sensation

Where does the decussation of the dorsal column pathway occur?

  • Superior pons
  • Medulla oblongata (correct)
  • Inferior pons
  • Cerebellum

Which of the following structures connects the brainstem to the cerebellum?

<p>Cerebellar peduncles (C)</p> Signup and view all the answers

Which cerebellar peduncle is associated with contralateral ataxia?

<p>Superior (C)</p> Signup and view all the answers

What characterizes the typical onset of the Subarachnoid hemorrhage (SAH) triad?

<p>2nd-3rd decade, presenting initially with hemorrhage. (D)</p> Signup and view all the answers

According to the Hunt and Hess scale, which grade indicates a patient who is confused and drowsy with a mild focal neurological deficit?

<p>Grade 3 (D)</p> Signup and view all the answers

Which of the following best describes the primary function of the Hunt and Hess grading scale in the context of subarachnoid hemorrhage (SAH)?

<p>To classify the severity of SAH based on clinical presentation. (C)</p> Signup and view all the answers

Which area of the brain does the Anterior Cerebral Artery (ACA) primarily supply?

<p>Medial frontal and medial parietal lobes. (A)</p> Signup and view all the answers

Besides the occipital lobe, which other area is NOT primarily supplied by the Middle Cerebral Artery (MCA)?

<p>Medial temporal lobe. (D)</p> Signup and view all the answers

According to the BELL MAGENDIE LAW, which of the following statements accurately describes the organization of the spinal cord?

<p>Sensory information enters through the posterior aspect, and motor commands exit through the anterior aspect. (A)</p> Signup and view all the answers

Where does the Upper Motor Neuron pathway terminate?

<p>Anterior gray matter (B)</p> Signup and view all the answers

Which of the following is characteristic of a Lower Motor Neuron lesion?

<p>Hypotonia (A)</p> Signup and view all the answers

What type of muscle fiber is innervated by alpha motor neurons?

<p>Extrafusal muscle fiber (C)</p> Signup and view all the answers

A patient presents with muscle weakness, fasciculations, and muscle cramping. Which of the following is the MOST likely underlying mechanism for the muscle cramping in this scenario?

<p>Upregulation of acetylcholine receptors (A)</p> Signup and view all the answers

Which area of the brain is primarily responsible for visual processing?

<p>Occipital lobe (A)</p> Signup and view all the answers

What is the MAIN difference between disuse atrophy and denervated atrophy?

<p>Disuse atrophy is typically observed in antigravity muscles, while denervated atrophy can result in severe muscle wasting. (D)</p> Signup and view all the answers

What is assessed by a Babinski sign?

<p>Upper motor neuron function (D)</p> Signup and view all the answers

Which type of aphasia is characterized by poor repetition skills, good comprehension, and poor fluency?

<p>Conduction aphasia (D)</p> Signup and view all the answers

A patient presents with poor fluency, good comprehension, and poor repetition. Which type of aphasia is most consistent with these symptoms?

<p>Broca's aphasia (A)</p> Signup and view all the answers

In which type of aphasia are fluency and comprehension both poor, but repetition is relatively preserved?

<p>Wernicke's aphasia (C)</p> Signup and view all the answers

Which of the following aphasias is associated with damage to the medial frontal border zone?

<p>Transcortical motor aphasia (A)</p> Signup and view all the answers

Which type of aphasia commonly results from damage to the angular gyrus?

<p>Anomic aphasia (A)</p> Signup and view all the answers

Which cranial nerves are typically affected in locked-in syndrome due to involvement of the pons and medulla oblongata?

<p>CN 5-12 (A)</p> Signup and view all the answers

Millard-Gubler syndrome is characterized by damage to which specific location within the pons?

<p>Lateral pons (D)</p> Signup and view all the answers

A patient presents with contralateral hemisensory loss of the body, ipsilateral hemisensory loss of the face, ataxia, and Horner syndrome. Which vascular syndrome is most likely?

<p>Wallenberg syndrome (C)</p> Signup and view all the answers

Which of the following structures is NOT typically affected in Wallenberg syndrome?

<p>Corticospinal tract (C)</p> Signup and view all the answers

Medial medullary syndrome is caused by occlusion of the anterior spinal artery, affecting the corticospinal tract and which cranial nerve?

<p>CN XII (C)</p> Signup and view all the answers

A patient exhibits ipsilateral CN 6 and 7 palsy along with contralateral hemiplegia. Which vascular syndrome is most likely?

<p>Millard-Gubler syndrome (C)</p> Signup and view all the answers

A patient with Wallenberg syndrome presents with difficulty swallowing, hoarseness, and loss of gag reflex. Damage to which structure is most likely responsible for these symptoms?

<p>Nucleus ambiguus (B)</p> Signup and view all the answers

Which of the following clinical findings is LEAST likely to be associated with locked-in syndrome?

<p>Intact motor function (A)</p> Signup and view all the answers

Which of the following characteristics is typically observed in the upper extremity flexion synergy pattern?

<p>Forearm supination (D)</p> Signup and view all the answers

In Brunnstrom's stages of recovery, what level of tone and movement is associated with Stage 1?

<p>Flaccidity with no movement (C)</p> Signup and view all the answers

Which of the following synergies includes ankle plantar flexion and inversion?

<p>LE Extension synergy (D)</p> Signup and view all the answers

What is the expected language ability profile (Good/Poor) for repetition, comprehension, and naming, respectively, in isolation of language, also known as 'Parang parrot'?

<p>Good, Poor, Poor (D)</p> Signup and view all the answers

What anatomical structure is associated with Pure Word Deafness?

<p>Heschl’s gyrus (C)</p> Signup and view all the answers

In the synergy patterns, which muscles are part of the spared group referred to as 'FLATS EDEMA'?

<p>Finger Flexors/Lats Dorsi (B)</p> Signup and view all the answers

What is the language ability profile in the condition where pure word vision and PCA are observed?

<p>Good repetition, Good comprehension, Poor naming (D)</p> Signup and view all the answers

Flashcards

Triad of SAH

The three key symptoms of Subarachnoid Hemorrhage: hemorrhage, migraine, and seizure.

Hunt and Hess Scale

A grading system to assess the severity of Subarachnoid Hemorrhage based on the patient's neurological status.

Grade 1 on Hunt and Hess

Awake patient with mild headache and slight nuchal rigidity.

MCA Blood Supply

Middle Cerebral Artery supplies the lateral part of the brain, except the occipital lobe.

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PCA Blood Supply

Posterior Cerebral Artery supplies the medial and inferior temporal and occipital lobes.

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Occipital Lobe

The part of the brain responsible for vision.

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Bell-Magendie Law

Law stating that posterior roots carry sensory and anterior roots carry motor information.

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Upper Motor Neuron (UMN)

Neurons that originate in the brain and send signals to lower motor neurons in the spinal cord.

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Lower Motor Neuron (LMN)

Neurons that extend from the spinal cord to skeletal muscles, controlling movement.

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Upper Motor Neuron Lesion Signs

Signs include hypertonia, spasticity, and increased deep tendon reflexes.

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Lower Motor Neuron Lesion Signs

Signs include hypotonia, flaccidity, and decreased deep tendon reflexes.

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Pathologic Reflexes

Reflexes indicating UMN lesions, such as the Babinski sign.

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Fasciculation

Involuntary muscle twitching seen in LMN lesions.

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Anomia

A language disorder characterized by the inability to name objects or retrieve words.

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Conduction Aphasia

A communication disorder where the ability to repeat phrases is impaired due to damage in the arcuate fasciculus.

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Broca's Aphasia

A type of non-fluent aphasia, where speech is labored and requires effort due to damage in Broca's area.

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Transcortical Sensory Aphasia

A condition where patients can't comprehend language but can repeat what they hear.

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Wernicke's Aphasia

A language disorder characterized by fluent but nonsensical speech, often with poor comprehension.

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Medial Lemniscus

A neural pathway in the brainstem for proprioception and tactile sensation.

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Cerebellar Peduncles

Connective structures linking the brainstem to the cerebellum; consists of three pairs.

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Spinocerebellar Tract

A pathway carrying proprioceptive information to the cerebellum.

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Dorsal Column-Medial Lemniscus System

Sensory pathway responsible for fine touch, vibration, and proprioception.

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Ataxia

Lack of voluntary coordination of muscle movements, often linked to cerebellar damage.

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Locked-in Syndrome

A condition where a person is aware but cannot move or speak due to paralysis, typically from brainstem damage.

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Millard-Gubler Syndrome

A brainstem stroke leading to contralateral hemiplegia and ipsilateral cranial nerve 6 and 7 palsy, found in the lateral pons.

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Wallenberg Syndrome

Result of lateral medullary stroke causing crossed hemisensory loss, affecting the face and body.

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Crossed Hemianesthesia

Contralateral body loss of sensation and ipsilateral facial loss due to brainstem lesions.

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Cranial Nerve Palsies

Weakness of specific cranial nerves resulting from brainstem syndromes, affecting CN 6-12 in various conditions.

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CST and CBT involvement

Corticospinal tract (CST) and corticobulbar tract (CBT) involvement indicates motor pathway damage in syndromes.

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I/L Weakness

Ipsilateral weakness seen in cranial nerve damage on the same side as the lesion.

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C/L Hemiplegia

Contralateral hemiplegia implies paralysis on the opposite side of the body from the brain lesion.

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Isolation of Language

A condition where comprehension is intact but the ability to express language is impaired.

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Global Aphasia

Severe language impairment affecting both comprehension and expression, linked to damage in Broca's and Wernicke's areas.

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Pure Word Deafness

A condition where a person cannot understand spoken words but can still produce speech.

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Pure Word Mutism

A condition characterized by the inability to speak while maintaining the ability to understand language.

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Alexia without Agraphia

A condition where a person cannot read but can still write.

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FLEXION Synergy

A pattern of movement where certain muscle groups contract to flex the upper and lower limbs.

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Brunnstrom’s Stage 1

The initial stage of recovery featuring flaccidity and absence of movement.

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Flaccidity

A state of decreased muscle tone, making limbs feel soft and lacking resistance to movement.

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Study Notes

Cerebrovascular Accident (CVA)

  • A CVA is a sudden loss of brain function due to a disruption of blood supply.
  • Upper motor neurons (UMN) are excitatory and inhibitory to lower motor neurons (LMN).
  • UMN injury results in weakness or paralysis.
  • Lesion locations affect body part impairment.
  • Internal capsule lesions cause weakness and paralysis.
  • Midbrain lesions can affect the corticospinal tract (CST) , the cerebral peduncle (AKA Basis Pedunculi), and other tracts.
  • Base of the pons also impacts motor pathways.
  • Pyrimidal tracts decussate (cross) laterally in the medulla.
  • Upper motor neuron lesions cause hypertonia, spasticity, and increased deep tendon reflexes.
  • Lower motor neuron lesions cause hypotonia, flaccidity, and decreased deep tendon reflexes.

Blood Supply of the Brain

  • Internal Carotid Artery (ICA) supplies the anterior parts of the brain.
  • Vertebral Arteries supply the posterior parts.
  • The anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) are major branches.
  • Watershed areas (no water) have a limited blood supply.
  • MCA branches provide supply to various brain regions.
  • PCA supplies the occipital and posterior temporal lobes.
  • Circle of Willis (COW) connects the anterior and posterior blood supplies.

Stroke Types and Definitions

  • Stroke (CVA, brain attack, or apoplexy) results from blood supply interruption to the brain.
  • Non-traumatic: typically lasting longer than 24 hours.
  • Transient ischemic attack (TIA, mini-stroke): brief interruption, less than 24 hours and no infarction.
  • Reversible ischemic neurologic deficit (RIND): typically lasting longer than 24 hours and no permanent damage.
  • Ischemic strokes are usually due to thrombotic or embolic occlusion.
  • Thrombotic strokes are caused by atherosclerotic plaques.
  • Embolic strokes are caused by emboli, such as blood clots.
  • Lacunar stroke is a small penetrating vessel blockage.

Etiologies of Stroke

  • Ischemic strokes are the most common type (80-85%).
  • Large vessel occlusion (30-40%) involves major arteries, often due to atherosclerosis.
  • Embolic strokes (30-35%) are caused by emboli originating elsewhere in the body (cardiac).
  • Small vessel occlusion (20%) affects smaller penetrating arteries, often due to small vessel disease.
  • Lacunar Strokes (57%) affect the subcortical areas and usually result in motor defects.

Hemorrhagic Stroke

  • Accounts for 15-20% of strokes.
  • Intracerebral hemorrhage: bleeding within the brain (often due to hypertension).
  • Subarachnoid hemorrhage: bleeding in the subarachnoid space (often from ruptured aneurysm).

Stroke Syndromes

  • Stroke syndromes are patterns of neurological deficits depending on the affected area of the brain.
  • MCA and ICA (Anterior circulation) causes various syndromes.
  • VBA (Brainstem) causes various syndromes.
    • Different syndromes are caused by different areas of the brain.

Grading Scale

  • Hunt and Hess scale is used to grade the severity of SAH based on patient status.

Stroke Recovery Stages

  • Brunnstrom stages describe the stages of recovery following a stroke.
  • Stage 1: Flaccidity and no movement;
  • Stage 2: Spasticity appears and minimal voluntary movement occurs.
  • Stages 3 and 4: Gradual improvement and increased voluntary movement.
  • Stage 5 and 6: Continued improvement in functional ability until a near-normal level of function is reached.
  • Stage 7: Normal.

Aphasia Types

  • Difficulty with communication due to brain damage.
  • Different types include (naming, comprehension, fluency, etc.).

Other Types of Syndromes

  • Locked-in syndrome.
  • Wallenberg syndrome.
  • Millard-Gubler syndrome.

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