Term
| Pt. presents with loss of vision in his left eye for less than 5 minutes. He describes it like a mist or haze "pulling down like a curtain". Identify the lesion. |
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Definition
Amaurosis Fugax (TIA) - Extracranial carotid artery disease - retinal emboli.
Get an carotid ultrasound. |
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Term
| Pt. presents with weakness on his right arm, leg, and face. He also has decreased sensation in those areas. He can't seem to talk, nor does he understand much commands. His eyes are directed toward the left. He can't name fingers and can't draw, while he used to in the past. On exam, he shows uniary incontinence and abulia (lack of will or initative). Identify the lesion. |
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Definition
| Left Internal Carotid stroke - with combined MCA/ACA findings. |
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Term
| Pt. presents with right-sided weakness of his face and arm. He has decreased sensation in those areas too. His eyes are also directed to the left. He can't seem to talk much, but he understands everything you say. Identify the lesion. |
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Definition
| Left Anterior branch of the MCA - MCA stroke w/ Broca's aphasia + right hemiplegia |
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Term
| Pt. eyes are directed to the left. On his drive to the ED, the patient complained of hitting trashcans and mailboxes, since he couldn't see them. He can talk, but everything that comes out is gibberish, though he can recite bible verses that he has memorized. Identify the lesion. |
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Definition
| Left Posterior branch of the MCA - MCA stroke w/ Wernicke's aphasia + right homonymous hemianopsia |
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Term
| Pt. presents to the ED with sudden onset confusion. He can't tell the difference between left and right, he can't name fingers, and he can't draw--e.g. a house. Identify the lesion. |
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Definition
| Left MCA stroke - angular and supramarginal gyrus - "Gerstmann's syndrome" |
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Term
| Pt. presents with left sided weakness in the arm and face and decreased sensation in those areas. Her eyes are directed to the right. She denies anything wrong with her and fails to recognize her left hand, though she can recognize her right. Identify the lesion. |
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Definition
| Right MCA stroke - right parietal lobe - anosognosia (denial of illness) or asomatosognosisa (denial of involved body parts) |
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Term
| Pt. presents with weakness in her right leg and decreased sensation in her leg as well. She reports urinary incontinence. |
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Definition
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Term
| Pt. presents with weakness in her right leg, arm, and face. However, she only has decreased sensation in her leg. She complains of urinary incontinence. |
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Definition
| Left ACA stroke w/ medial lenticulostriate artery involvement (pure motor weakness of contralateral face/arm) |
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Term
| Pt. presents with bilateral weakness and sensory loss in her legs. She has no joy, and takes her time to respond to physicians. She lacks spontaneity and also demonstrates frontal lobe release signs. Identify the lesion. |
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Definition
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Term
| Pt. presents with right sided weakness and sensory loss in her arm, face, and leg. She has a right-sided visual field deficit, with a beaklike zone sparing horizontally. No other cortical signs present - aphasia, neglect, etc. Identify the lesion. |
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Definition
| Left anterior choroidal artery stroke - post. limb of internal capsule (hemiplegia and hemisensory); GPi (contralateral homonymous hemianopsia w/ beaklike sparing) |
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Term
| Pt. presents with weakness in her left arm and leg. No weakness in her face is observed. She also has loss of vibration and proprioception in her left side. Her tongue is deviated to the right. Identify the lesion. |
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Definition
| Right vertebral artery stroke - medullary pyramid (contralateral hemiplegia), medial lemniscus (contra vibration/proprioception), CN XII (ipsi tongue deviation) |
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Term
| Pt. presents with decreased pain and temperature in her left leg, but decreased pain and temperature in her right face. She also has right ptosis, decreased sweating, and small right pupil. She has some difficulty moving her right arm and leg. Her voice turned hoarse, and she has difficulty swallowing, and has hiccups. She has had nausea and vomiting, and has described the room spinning in circles. She also has nystagmus and decreased gag reflex on exam. |
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Definition
| Right Posterior inferior cerebellar artery - crossed findings mean Posterior circulation! Ipsi - cranial nerves and contra - body |
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Term
| Pt. presents with decreased pain and temperature in her left leg, but decreased pain and temperature in her right face. She also has right facial paralysis. She also has right ptosis, decreased sweating, and small right pupil. She has some difficulty moving her right arm and leg. She has had nausea and vomiting, and has described the room spinning in circles. She also has nystagmus. She has no hiccups, or difficulties swallowing. However, you notice that she has difficulty hearing on the right side and has complained of ringing in her right ear. |
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Definition
| Right anterior inferior cerebellar artery - |
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Term
| Pt. presents with left-sided ataxia and gait ataxia. She has tremor in her left arm and it increases as her arm approaches the endpoint of deliberate and visually guided movement. She also has chorieform dyskinesia. On exam, she has decreasing hearing on her left hear and loss of pain and temperature on he right side. She also has pseudobulbar speech. |
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Definition
| Left Superior cerebellar artery |
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Term
| Pt. presents with bilateral arm and leg weakness and sensory deficit. She is unable to respond or communicate, except by looking up or down. |
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Definition
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Term
| Pt. has right sided facial paralysis and double vision whenever her eyes look to the right. Identify the lesion. |
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Definition
| Basilar artery stroke - lateral pons |
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Term
| Pt. has left sided weakness and her eyes are directed toward the left. Identify the lesion. |
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Definition
| Basilar artery stroke - PPRF-6th nerve complex |
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Term
| Pt. has double vision and an INO. Identify the lesion. |
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Definition
| Basilar artery stroke - medial longitudinal fasciulus |
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Term
| Pt. presents with bilateral arm and leg weakness and sensory deficit and ipsilateral ataxia. Identify the lesion. |
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Definition
| Basilar artery stroke - cerebellar involvement |
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Term
| Pt. presents with bilateral arm and leg weakness and sensory deficit and has blindness. Identify the lesion. |
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Definition
| Basilar artery stroke - bilateral PCA involvement |
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Term
| Pt. has weakness on the left side and her right eye is down and out. Identify the lesion. |
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Definition
| Right Posterior Cerebral Artery - Weber's syndrome |
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Term
| Pt. has decreased sensation and weakness on the left side and her right eye is down and out. Identify the lesion. |
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Definition
| Right Posterior Cerebral Artery - Webner's syndrome + thalamogeniculate branch to thalamus involvement |
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Term
| Pt. has right sided homonymous hemianopsia with macular sparing, memory difficulties, and no aphasia, neglect, and hemiparesis and hemisensory loss. She can't read, but can draw and write. Identify the lesion. |
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Definition
| Left Posterior cerebral artery - left occipital lobe and splenium of the corpus callosum |
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Term
| Pt. presents with blindness, but denies that she is blind. Identify the lesion. Other patients like her can identify parts of a picture, but cannot grasp the entire picture. |
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Definition
| Bilateral PCA stroke - Anton syndrome or simultanagnosia (recognize parts, but not the whole) |
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Term
| Pt. cannot identify people's faces, but can recognize people by their body shape, or their watch. |
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Definition
| Bilateral PCA stroke - Bilateral mesiotemporal-occiptital stroke - prosopagnosia |
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Term
| Patient presents with UMN weakness of her left face, arm, and leg. No sensory losses are noted. Identify the lesion. |
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Definition
| Right Lenticulostriate branch of the MCA stroke - small vessel stroke (also corona radiate and basis pontis) |
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Term
| Patient presents with suddent loss of sensation, numbess, and tingling in her right face, arm, and leg. No weakness noted on exam. Identify the lesion. |
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Definition
| Left thalamogeniculate branch of the PCA stroke - small vessel stroke |
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Term
| Patient presents with wild, flinging movements on her left side of her body. Identify the lesion. |
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Definition
| Right subthalamic nucleus |
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Term
| Patient presents with profound dysarthria, dysphagia, emotional incontinence, and congitive deficits. She has a history of past subcortical strokes. |
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Definition
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Term
| Pt. presents with right-sided weakness and visual field loss. He also has headache, nausea, and cognitive deficits. Identify the lesion. |
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Definition
| Left Putaminal Hemorrhage -> Inc. ICP -> headache -> get a CT! Mortality = 33% |
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Term
| Patient has left sided sensory defecits, and his left eye has difficult with vertical eye movements. He also has headache, nausea, and cognitive deficits. |
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Definition
| Right thalamic hemorrhage -> get CT! Mortality = 50% |
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Term
| Patient has coma and loss of consciousness. Prior to that, he also has headache, nausea, and cognitive deficits. On exam you notice pinpoint pupils. |
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Definition
| Pontine hemorrhage; Mortality = 72% |
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Term
| Patient presents with headache in the occipital region, a stiff neck, nausea and vomitting, vertigo, and an inability to walk. He has left sided ataxia and nystagmus on examination. |
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Definition
| Left cerebellar hemorrhage -> get a CT since you can operate on this! |
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Term
| A 55 y/o man with a history of hypertension, smoking, and polycystic kidney disease presents with sudden onset, severe headache, and drowsiness, confusion, nausea, and vomitting. He says he was lifting weights when it happened. On exam he has a third nerve palsy, and his neck pain is worsened by neck flexion. He also has subhyaloid retinal hemorrhage on fundoscope exam. Identify the lesion. |
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Definition
Subarrachnoid hemorrhage (SAH) -> berry aneurysm (or saccular aneurysm popped!) -> bifurcations on the COW, esp. the anterior part of the COW; in this case, it was a Pcomm rupture => 3rd nerve palsy.
1. Get a CT -> check for tumor (should reveal hemorrhage)
2. If clear, get a lumbar puncture
3. Get angiogram -> confirm aneurysm
4. Neurosurgery |
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