questions 3

Circle of Willis

Topic updated on 03/24/17 3:30pm

Overview
 
                   

                             

Snapshot
  • A 59-year-old male presents with sensory changes on the right side of his face, left side of his body, and dizziness. He also reports some trouble with swallowing, and his wife noticed that his voice sounds hoarse. Past medical history is significant for hypertension and type 2 diabetes mellitus. On physical examination, there is a right-sided Horner’s syndrome. Uvula is deviated towards the left. There is right-sided vocal cord paralysis and absence of elevation of the right palate during phonation. There is loss of pain sensation on the right-sided face and left-sided trunk and limbs. (Lateral medullary syndrome)
 
Introduction
 
 
Artery Syndrome Presentation
Anterior Spinal artery
  • Medial medullary syndrome
  • Ipsilateral paralysis of hypoglossal nerve 
  • Contralateral hemiparesis of the upper and lower extremity
  • Medial lemniscus (↓ contralateral vibration and proprioception) 
Posterior inferior cerebellar artery (PICA)
  • Lateral medullary syndrome 
  • Ipsilateral manifestations
    • facial loss of pain and temperature
    • ataxia (arm and leg, gait)
    • hoarseness
    • dysphagia
    • Horner syndrome
  • Contralateral manifestations
    • pain and temperature hemisensory loss
  • Nausea, nystagmus, vomiting, vertigo
Anterior inferior cerebellar artery (AICA)
  • Lateral pontine syndrome
  • Ipsilateral manifestations
    • facial paralysis
    • loss of lacrimation
    • reduced salivation
    • loss of corneal reflex
    • loss of sensation of the anterior 2/3rd of the tongue
    • Horner syndrome
    • sensorineural hearing loss
    • loss of facial pain and temperature
  • Contralateral manifestations
    • pain and temperature hemisensory loss
Posterior cerebral artery
-
  • Contralateral homonymous hemianopia with macular sparing
Middle cerebral artery -
  • Contralateral manifestations
    • facial paralysis and sensory loss
    • upper extremity weakness and sensory loss
    • hemineglect (if stroke is in non-dominant hemisphere)
    • aphasia (if stroke is in dominant hemisphere-Broca's area)
Anterior cerbral artery
-
  • Contralateral manifestations
    • lower extremity weakness and sensory loss
Posterior communicating artery
-
  • Ipsilateral compression leading to CN III palsy
    • down-and-out, mydriasis
Lenticular striate artery
-
  • Contralateral manifestations
    • motor hemiparesis
    • hemisensory loss
  • Lack of cortical signs
    • no aphasia, neglect
Basilar artery
  • Locked-in syndrome
  • Quadriplegia
  • Preserved reticular formation
  • Intact vertical eye movement
  • Intact blinking
Anterior communicating artery
-
  • Can compression of optic chiasm
    • bitemporal hemianopia
  • If rupture, ischemia in anterior cerebral artery territory




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