Stroke Pathophysiology & Patient Assessment Flashcards

A patient presents with contralateral leg weakness that is greater than arm weakness, plus urinary incontinence. Which artery is most likely occluded?

Answer: Anterior cerebral artery

The ACA supplies the medial frontal and parietal lobes, where the leg and foot are represented on the motor homunculus.

Ipsilateral loss of facial pain and temperature, contralateral loss of body pain and temperature, dysphagia, and ipsilateral Horner syndrome suggest occlusion of which vessel?

Answer: Posterior inferior cerebellar artery or vertebral artery

This is lateral medullary (Wallenberg) syndrome, usually from PICA or vertebral artery occlusion.

A pure motor hemiparesis affecting face, arm, and leg equally with no sensory, visual, or cognitive deficits most likely results from a lacune in which location?

Answer: Posterior limb of the internal capsule

The posterior limb of the internal capsule carries tightly packed corticospinal fibers, so a small lacune there causes pure motor stroke.

A right-handed patient with right hemiparesis, worse in the face and arm, and nonfluent speech with relatively preserved comprehension most likely had a stroke in which territory?

Answer: Left MCA superior division

The left MCA superior division supplies Broca's area and the face and arm motor cortex in the dominant hemisphere.

Contralateral homonymous hemianopia with macular sparing is most characteristic of occlusion of which artery?

Answer: Posterior cerebral artery

PCA occlusion infarcts the occipital cortex, and macular sparing happens because of collateral MCA supply to the occipital pole.

A patient is quadriplegic and unable to speak but is fully conscious and can communicate with vertical eye movements. Which lesion is most likely?

Answer: Ventral pontine infarct from basilar artery occlusion

Locked-in syndrome results from ventral pontine damage that spares the reticular activating system and vertical gaze centers.

Agraphia, acalculia, finger agnosia, and left-right disorientation together indicate a lesion of which area?

Answer: Dominant angular gyrus

This tetrad is Gerstmann syndrome, which localizes to the dominant (usually left) angular gyrus of the parietal lobe.