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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    Cerebrovascular Accident PDF

    Description

    Test your knowledge on cerebrovascular accidents (CVA) and the blood supply of the brain. This quiz covers the effects of upper and lower motor neuron lesions, as well as the major arteries supplying the brain. Understand the clinical implications of various lesions and their impact on function.

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