OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• neurology
• stroke (CVA)
• weakness_UL
• weakness of the lower limb(s) / weak in the knees
• paraesthesiae or numbness

• lesion in the pons, posterior limb of internal capsule, or cerebral peduncle
• paralysis of face, arm, and leg without sensory loss
• no parietal lobe findings

• lesion usually in the thalamus
• sensory loss of face, arm, and leg with no hemiplegia or other signs

• lesion in the pons, anterior limb or genu of internal capsule (eg. lenticulostriate vessels)
• slurred speech with clumsiness and mild weakness of one arm

• lesion in the contralateral pons, post. limb of internal capsule, or contralateral thalamus
• ataxia and weakness of one leg

• contralateral hemiplegia
• eyes deviate to side of the lesion
• pupils normal size and reactive
• headache and often a field defect
• cortical deficits develop as the bleed progresses

• +/- hemiplegia
• eyes look down and in towards nose
• impaired upward gaze
• pupils small and reactive
• marked sensory loss

• usually fatal
• coma with small pinpoint pupils which react to bright light when viewed through magnifying glass
• quadriparesis with upgoing plantars
• no horizontal extraocular movements with passive head turning or use of ice water calorics

• hemiparesis and cortical sensory loss - both greater in face and arm than in leg
• aphasia and alexia if left brain
• non-dominant hemisphere findings if right brain
• homonymous hemianopia
• conjugate eye deviation to the side of the brain lesion
• may be partial due to emboli and present as only one of the following:
  • sensorimotor paresis with little aphasia
  • fluent aphasias: anomic, conduction, Wernicke's, transcortical sensory, subcortical aphasia
  • nonfluent aphasias: Broca's, transcortical motor, global and mixed transcortical aphasia
  • agraphia - as inability to write requires language processing, spelling, visual perception, visuo-spatial orientation for graphic symbols, motor planning, and motor control of writing
  • alexia - acquired inability to read
    • pure alexia with agraphia
    • pure alexia without agraphia
    • alexia associated with aphasia ('aphasic alexia')
  • acalculia (acquired deficits in mathematical calculation)
    • acalculia associated with language disturbances, including number paraphasia, number agraphia, or number alexia
    • acalculia secondary to visuospatial dysfunction with malalignment of numbers and columns
    • primary anarithmetria entailing disruption of the computation process

• cortical sensory loss and paralysis of leg
• incontinence
• grasp and suck reflexes
• slowness in mentation with perseveration
• no hemianopsia or aphasia
• left limb apraxia

• may give combined middle cerebral artery and anterior cerebral artery findings
• tend to be stuporous or semi-comatose due to the large infarct

• homonymous hemianopia
• little or no paralysis
• prominent sensory loss
• no aphasia
• +/- ability to write but not read and inability to name colors
• +/- recent memory loss (if hippocampus involved)
• +/- acute confusional state, especially initially

• proximal arm weakness with distal sparing
• transcortical aphasias

• never have cortical defects or visual field defects

• often involve CIII or nucleus and cerebral peduncle resulting in Weber's syndrome:
  • ipsilateral pupil dilatation, ptosis, ophthalmoparesis
  • contralateral hemiplegia

• weakness
• internuclear ophthalmoplegia or gaze palsy with little sensory loss

• sensory loss predominates
• ipsilateral cerebellar signs if lateral pontine

• upper pons:
  • contralateral facial paralysis sparing forehead
  • contralateral pain and sensory loss in both face and extremities
• middle pons:
  • trigeminal nerve exits
  • ipsilateral trigeminal nerve lesion ⇒ loss of corneal reflex and facial sensory loss
  • contralateral pain & temperature loss in limbs
• lower pons:
  • facial nerve exits
  • eighth nerve and nucleus
  • ipsilateral facial nerve (upper and lower) paralysis
  • descending tract of trigeminal nerve lesion resulting in ipsilateral facial pinprick and temperature loss
  • ipsilateral deafness and vertigo (eighth nerve lesion)

• caused by occlusion of vertebral or post inf cerebellar artery
• ipsilateral:
  • facial numbness
  • limb ataxia
  • Horner's syndrome
  • pain over the eye
• contralateral:
  • pin prick and temperature loss in arm and leg
• vertigo, nausea, hiccups, hoarseness, difficulty swallowing & diplopia