Which of the following signs and symptoms might persist after partial occlusion of the basilar artery? Indicate ALL correct answers.

a. Weakness or paralysis one arm and leg (hemiplegia)
b. Loss of touch sensation on the face
c. Weakness or paralysis of both arms and legs (quadriplegia)on only the left side
d. Double vision (diplopia)
e. Problems with coordinating fine movements and with gait
f. Problems understanding spoken or written language, accompanied by fluent speech

Which of the following problems might be seen after a stroke involving the vertebral artery that infarcts the left side of the rostral medulla, but spares midline regions? Indicate ALL correct answers.

a. Inability to see things on the left side (left homonymous hemianopsia)
b. A drooping left eyelid (mild ptosis) and a small left pupil (miosis)
c. Choking on food because of problems with swallowing
d. Hoarse voice
e. Vertigo, nausea, and vomiting
f. Paralysis of the right leg, accompanied by brisk deep tendon /muscle stretch reflexes

A lacunar stroke in either the internal capsule or the base (ventral-medial region) of the pons could produce a pure motor syndrome: weakness or paralysis of the arm or leg on one side with no other findings.

Question a.  In each case, on which side does paralysis occur?

a. same side as the lesion
b. opposite side from the lesion

Question b.  In each case, the stroke is produced by occlusion of slender vessels that penetrate deeply into the brain. Branches of MCA supply the internal capsule; branches of what major vessel supply the ventral-medial pons?

Question c.  Lacunar strokes also occur commonly in the thalamus, where they can produce a pure hemisensory deficit. Branches of what major vessel supply most of the thalamus?

In 1-2 sentences, what is the problem with memory that is commonly produced by bilateral PCA occlusion? What major gray matter and/or white matter structures are infarcted?

The primary visual cortex in the medial occipital lobe is supplied by cortical branches of which major cerebral artery?

In some but not all individuals, the posterior tips of the occipital lobes are in the border zone formed between which two major cerebral arteries?

What is functionally important about this particular part of the primary visual cortex?

List 4 problems that a patient might commonly experience during a TIA produced by ischemia in brain tissue supplied by the vertebral-basilar circulation.

1. 2. 3. 4.

Which of the following signs and symptoms might persist after partial occlusion of the basilar artery? Indicate ALL correct answers.

Your Answer	Correct Answers: a,b,c, d,e
a. Weakness or paralysis one arm and leg (hemiplegia)	a. Weakness or paralysis one arm and leg (hemiplegia)
b. Loss of touch sensation on the face	b. Loss of touch sensation on the face
c. Weakness or paralysis of both arms and legs (quadriplegia)	c. Weakness or paralysis of both arms and legs (quadriplegia)
d. Double vision (diplopia)	d. Double vision (diplopia)
e. Problems with coordinating fine movements and with gait	e. Problems with coordinating fine movements and with gait
f. Problems understanding spoken or written language, accompanied by fluent speech	f. Problems understanding spoken or written language, accompanied by fluent speech

Which of the following problems might be seen after a stroke involving the vertebral artery that infarcts the left side of the rostral medulla, but spares midline regions? Indicate ALL correct answers.

Your Answer	Correct Answers: b,c, d,e
a. Inability to see things on the left side (left homonymous hemianopsia)	a. Inability to see things on the left side (left homonymous hemianopsia)
b. A drooping left eyelid (mild ptosis) and a small left pupil (miosis)	b. A drooping left eyelid (mild ptosis) and a small left pupil (miosis)
c. Choking on food because of problems with swallowing	c. Choking on food because of problems with swallowing
d. Hoarse voice	d. Hoarse voice
e. Vertigo, nausea and vomiting	e. Vertigo, nausea and vomiting
f. Paralysis of the right leg, accompanied by brisk deep tendon /muscle stretch reflexes	f. Paralysis of the right leg, accompanied by brisk deep tendon /muscle stretch reflexes

Question a.  In each case, on which side does paralysis occur - same side as the lesion or opposite?

Your Answer	Correct Answer: b
a. same side as the lesion	a. same side as the lesion
b. opposite side from the lesion	b. opposite side from the lesion

Question b.  In each case, the stroke is produced by occlusion of slender vessels that penetrate deeply into the brain. Branches of MCA supply the internal capsule; branches of what major vessel supply the ventral-medial pons?

Your Answer	We Were Looking For:
	The basilar artery supplies the ventral-medial pons.

Question c.  Lacunar strokes also occur commonly in the thalamus, where they can produce a pure hemisensory deficit. Branches of what major vessel supply most of the thalamus?

Your Answer	We Were Looking For:
	PCA branches supply most of the thalamus, especially the part containing the somatosensory nuclei.

In 1-2 sentences what is the problem with memory that is commonly produced by bilateral PCA occlusion? What major gray matter and/or white matter structures are infarcted?

Your Answer	We Were Looking For:
	Patients with bilateral PCA occlusions cannot remember new information for more than about 45-60 seconds. Thus they cannot remember events that have occurred since their stroke, and often those that occurred shortly before the stroke. This devastating memory problem could be produced by bilateral infarction of the hippocampal formation and/or posterior parts of the fornix.

Question a. The primary visual cortex in the medial occipital lobe is supplied by cortical branches of which major cerebral artery?

Your Answer	We Were Looking For:
	The medial occipital lobe is supplied by cortical branches of PCA.

Question b.  In some but not all individuals, the posterior tips of the occipital lobes are in the border zone formed between which two major cerebral arteries?

Your Answer	We Were Looking For:
	The tips of the occipital lobes are sometimes in the MCA-PCA border zone (other times they are entirely in PCA territory).

Question c.  What is functionally important about this particular part of the primary visual cortex?

Your Answer	We Were Looking For:
	This is the region of the primary visual cortex in which objects at the center of vision (objects that fall on the macula of the retina) are represented; thus certain individuals may suffer a PCA occlusion and yet retain central vision (so-called 'macular sparing' ).

List 4 problems that a patient might commonly experience during a TIA produced by ischemia in brain tissue supplied by the vertebral-basilar circulation.

Your Answer	We Were Looking For four of the following:
	Weakness or paralysis of the face, arm or leg on one or both sides Numbness, tingling, or other sensory problems involving the face, arm or leg on one or both sides Problems speaking clearly (dysarthria). Problems with gait or limb coordination or with balance Vertigo (sense that the world is spinning) or dizziness Diplopia (double vision), blindness or homonymous hemianopsia

End of Self Test
Module 5