Let’s take a look at Ischemic stroke syndromes.
Pure motor hemiplegia. Contralateral pons or internal capsule lacunar.
So in a vascular pathology, you're gonna have these larger arteries that are affected,
that’ll be the middle cerebral artery and the anterior cerebral artery, so on and so forth.
Or there's something called the lacunar infarct.
Say that your patient has had long term hypertension.
Remember we said that hypertension is extremely common risk for stroke taking place
and if the hypertension is taking place over a long period of time you can only imagine that there is really no blood vessel
that is left safe, right, so they're all vulnerable to some type of pathology.
And say that you have little blood vessels that are now undergoing compromise and undergoing damage and injury,
and many times, patients with hypertension will have lacunar infarct but if that part of the brain is not significant
in terms of proper functioning and then the patient may asymptomatic,
but if it is an internal capsule that’s been affected such as a caudate, putamen,
or even the thalamus or sub-thalamus;
and then you will have motor type of issues and this would be a pure motor contralateral type of hemiplegia, wouldn't it?
And so maybe therefore there’s interesting gaits that you've talked about earlier where the arm might be adducted
and the hand might be flexed and then the -- you have circumduction that’s taking place in the leg
and you have internal rotation of the ankle and so forth and you have that particular gait, right,
and so that’s referring to what’s known as your pure motor type of hemiplegia internal capsule.
So let’s take a look at another one.
Pure sensory stroke, contralateral thalamus is here once again, little blood vessels that might undergo strokes, a lacunar type of infarct.
Now maybe it’s a big blood vessel that has been affected, our middle cerebral artery.
So think about that, please.
So this is an artery that’s been affected and you know about your watershed areas, right?
And by watershed I'm referring to two blood vessels that are coming together
and when they do, it’s that particular tissue that is now susceptible to a damage and so for example middle cerebral artery
and anterior cerebral artery would be an area in which you call that watershed.
And I told you earlier, middle cerebral artery would be supplying the lateral aspect of the parietal lobe
responsible for sensations and activity in the upper extremity, maybe the head and neck.
Well, let’s say that there is an MCA type of issue and there is an atherosclerotic type of ischemic stroke taking place,
then please understand that the hemiparesis will be taking place in the face and the arm,
much more so than the leg, right? Because of the homunculus in the representation.
There might be aphasia if it’s the dominant side, sensory loss, might be hemianopsia or eye deviation
if there's enough damage of your MCA taking places, so keep that in mind.
Aphasia, more or less referring to the dominant side. How do you know which side of the brain is dominant in your patient?
You're going to be looking for clues as to what arm your patient is more comfortable using,
right or left and then obviously the contralateral hemisphere is going to be the dominant side.
Anterior cerebral artery.
What about this syndrome?
Well, here think about the anterior cerebral artery, please, and you are supplying the medial aspect of your brain
and so therefore this then represents your legs and lower extremity; so lower extremity weakness, sensory loss,
maybe even perhaps incontinence or limb apraxia.
What does that mean to you?
You are not able to carry out those learned motor type of functioning.
Anterior cerebral artery. Where are you? The medial aspect of the brain.
What about the posterior cerebral artery?
Well, the posterior cerebral artery, more or less, think of it as being part of your occipital lobe, posteriorly.
You should be thinking about vision, there might be homonymous hemianopsia. There might be sensory loss as well.
Then you have from the Circle of Willis, think about the posterior inferior cerebellar artery,
okay, so we have PICA. And here, I’ll see patient going to present and I'm gonna present like this, doc.
So there might be hoarseness that’s taking place.
Doc, I'm having a hard time eating, so there might be dysphagia that’s taking place, right?
So if there's a couple of things that you wanna take out of what's on Wallenberg syndrome, and your PICA
and you must keep in mind the big symptoms such as dysphagia, such as hoarseness.
You might have ataxia or Horner’s syndrome, ipsilateral loss of facial sensation, contralateral loss of body in sensation if it’s PICA.
This is referred to as your Wallenberg Syndrome.
Now, with PICA, would you call this a medial-mediolate type of syndrome or would you call this a lateral mediolate type of syndrome?
Keep that in mind, I’ll answer that question in just a minute.
Why don’t you come back and spend some time with me.