Stroke Localisation

Question 1

What is the most common site of ischemic stroke?

Answer 1

The Middle Cerebral Artery (MCA) territory.

Question 2

What is the typical motor deficit in MCA stroke?

Answer 2

Contralateral hemiparesis, affecting the face and arm more than the leg.

Question 3

What is the typical sensory deficit in MCA stroke?

Answer 3

Contralateral sensory loss, especially in the face and arm > leg.

Question 4

What visual field defect is associated with MCA stroke?

Answer 4

Contralateral homonymous hemianopia, due to optic radiation involvement.

Question 5

What language deficit occurs in MCA stroke of the dominant hemisphere (usually left)?

Answer 5

Aphasia – can be Broca’s, Wernicke’s, or global, depending on the lesion site.

Question 6

What neurocognitive deficits occur in MCA stroke of the non-dominant hemisphere (usually right)?

Answer 6

Neglect, anosognosia (denial of deficit), and spatial disorientation.

Question 7

What eye sign is often seen in MCA stroke?

Answer 7

Gaze preference towards the side of the lesion, due to frontal eye field involvement.

Question 8

Which areas of the brain are supplied by the Anterior Cerebral Artery (ACA)?

Answer 8

The medial frontal and parietal lobes.

Question 9

What is the typical motor deficit in ACA stroke?

Answer 9

Contralateral leg weakness greater than arm/face weakness.

Question 10

What is the typical sensory deficit in ACA stroke?

Answer 10

Contralateral sensory loss in the leg more than arm/face.

Question 11

What urinary symptom may occur in ACA stroke, and why?

Answer 11

Urinary incontinence, due to involvement of the medial frontal micturition center.

Question 12

What changes in behavior can be seen in ACA stroke?

Answer 12

Abulia (loss of initiative), personality changes, and behavioral disturbances.

Question 13

Which type of aphasia can occur in ACA stroke of the dominant hemisphere?

Answer 13

Transcortical motor aphasia.

Question 14

What is the hallmark symptom of ophthalmic/retinal artery ischemia (amaurosis fugax)?

Answer 14

Transient monocular blindness, described as a “curtain descending over vision.”

Question 15

What is the most common cause of amaurosis fugax?

Answer 15

Emboli from ipsilateral carotid artery disease

Question 16

Is amaurosis fugax considered a stroke or a TIA?

Answer 16

It is a transient ischemic attack (TIA) affecting the retinal circulation.

Question 17

Which areas of the brain are supplied by the Posterior Cerebral Artery (PCA)?

Answer 17

The occipital lobe, inferior temporal lobe, and thalamus.

Question 18

What is the typical visual field defect in PCA stroke?

Answer 18

Contralateral homonymous hemianopia, often with macular sparing.

Question 19

What higher visual/language deficits may occur in PCA stroke of the dominant hemisphere?

Answer 19

Visual agnosia and alexia without agraphia

Question 20

What is the thalamic syndrome associated with PCA stroke?

Answer 20

Contralateral sensory loss that progresses to severe pain (thalamic pain syndrome).

Question 21

Why are basilar artery strokes considered severe?

Answer 21

They are often severe and frequently fatal, due to brainstem involvement.

Question 22

What motor deficit is seen in basilar artery stroke?

Answer 22

Quadriplegia

Question 23

What is “locked-in syndrome” seen in basilar artery stroke?

Answer 23

The patient is conscious but paralyzed, with only vertical eye movements preserved

Question 24

Which additional neurological signs are common in basilar artery stroke?

Answer 24

Cranial nerve palsies.

Question 25

Which artery is most commonly involved in lateral medullary syndrome?

Answer 25

Posterior inferior cerebellar artery (PICA) or vertebral artery.

Question 26

What sensory deficit pattern is seen in lateral medullary syndrome?

Answer 26

Ipsilateral loss of pain/temperature on face (trigeminal nucleus) and contralateral loss on body (spinothalamic tract).

Question 27

What cerebellar signs are present in lateral medullary syndrome?

Answer 27

Ipsilateral ataxia, vertigo, and nystagmus

Question 28

What cranial nerve findings are seen in lateral medullary syndrome?

Answer 28

Dysphagia, dysarthria, hoarseness, and loss of gag reflex (CN IX and X involvement).

Question 29

Which artery is typically involved in medial medullary syndrome?

Answer 29

Anterior spinal artery

Question 30

What motor deficit is seen in medial medullary syndrome?

Answer 30

Contralateral hemiparesis of arm and leg (corticospinal tract).

Question 31

What sensory deficit occurs in medial medullary syndrome?

Answer 31

Contralateral loss of proprioception and vibration sense (medial lemniscus).

Question 32

What cranial nerve finding characterizes medial medullary syndrome?

Answer 32

Ipsilateral tongue weakness (CN XII palsy, tongue deviates to lesion side).

Question 33

Which artery is typically involved in Weber’s syndrome? Midbrain stroke

Answer 33

Branches of the posterior cerebral artery (PCA) supplying the midbrain.

Question 34

What cranial nerve deficit is seen in Weber’s syndrome?

Answer 34

Ipsilateral CN III palsy → ptosis, dilated pupil, eye deviated “down and out.”

Question 35

What motor deficit is seen in Weber’s syndrome?

Answer 35

Contralateral hemiparesis of face, arm, and leg (corticospinal tract involvement).

Question 36

What classic neurological feature does Weber’s syndrome illustrate?

Answer 36

A “crossed syndrome” – cranial nerve deficit on one side, long tract signs on the opposite side.

Question 37

Where is the lesion in Millard-Gubler syndrome?

Answer 37

The ventral pons.

Question 38

Which cranial nerves are affected in Millard-Gubler syndrome?

Answer 38

Ipsilateral CN VI (abducens) and CN VII (facial) palsy.

Question 39

What long tract sign is present in Millard-Gubler syndrome?

Answer 39

Contralateral hemiparesis (due to corticospinal tract involvement).

Question 40

What classic neurological feature does Millard-Gubler syndrome demonstrate?

Answer 40

A crossed brainstem syndrome – cranial nerve palsy on one side with motor deficit on the opposite sid

Question 41

Where is the lesion in locked-in syndrome?

Answer 41

The ventral pons, usually due to basilar artery thrombosis.

Question 42

What motor deficit is seen in locked-in syndrome?

Answer 42

Quadriplegia – complete paralysis of all voluntary muscles of the body.

Question 43

What cranial nerve functions are preserved in locked-in syndrome?

Answer 43

Vertical eye movements and blinking, controlled by the midbrain (not affected by pontine lesion).

Question 44

What is the level of consciousness in locked-in syndrome?

Answer 44

Patients are fully conscious and aware, but unable to move or speak.

Question 45

How do patients with locked-in syndrome communicate?

Answer 45

Typically through vertical eye movements and blinking.