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Introduction Cerebrovascular disease is a type of acute neurological disease, but the symptoms and severity of the patient depend on the involved location and the nature of the disease.
This article will bring you 5 different types of cerebrovascular disease cases, and conduct a simple quiz for the patient's lesion location problem, come and try your skills.
Case: A 180-year-old male with right-handedness, sudden right-handed limb weakness, decreased speech and comprehension, went to see a doctor.
The patient has a history of hypertension and dyslipidemia, and is taking antihypertensive drugs and statins.
Physical examination revealed that the patient was completely aphasia, with central facial paralysis on the right side, hemiplegia on the right side, positive Babinski sign, and loss of feeling on the right side.
What is the most likely blood vessel involved in the patient? A.
Left middle cerebral artery B.
Right middle cerebral artery C.
Left posterior cerebral artery D.
Right posterior cerebral artery As shown in the figure, a large area of low-density shadow can be seen in the blood supply area of the patient’s left middle cerebral artery, midline direction Shift right.
The manifestations of specific neurological deficits in ischemic stroke mainly depend on the blocked arteries and the affected brain volume.
As shown in the figure below, the anterior cerebral artery (ACA) supplies blood to the medial frontal lobe, the posterior cerebral artery (PCA) supplies the occipital lobe, the medial temporal lobe, part of the midbrain and thalamus, and the middle cerebral artery (MCA) is responsible for the parietal and lateral lobe.
Frontal and temporal lobes, insula, internal capsule and basal ganglia area.
The 240-year-old male of the case presented to the doctor due to poor speech, weakness of the right limb, and headache.
He had vomited twice since the onset of illness.
The patient has a history of hypertension for 5 years, but his medication compliance is poor.
The patient was conscious and oriented.
The blood pressure was 170/100 mmHg and the pulse rate was 80 beats/min.
The neurological examination confirmed the patient's right hemiplegia and Babinski sign was positive.
The treating doctor suspected that the patient had cerebral hemorrhage.
What is the most likely bleeding site in this patient? A.
Basal ganglia B.
Thalamus C.
Pons D.
Cerebellum As shown in the picture, hemorrhage can be seen in the basal ganglia area on the left of the patient, and there is no evidence of significant subarachnoid hemorrhage and ventricular dilatation.
Hypertension damages the small perforating arteries in the brain, which mainly supply deep brain structures, including the basal ganglia, internal capsule, thalamus, pons, and cerebellum.
Among them, basal ganglia hemorrhage is the most common in hypertensive intracerebral hemorrhage.
The lenticular artery that supplies this place is emitted from the middle cerebral artery at a right angle and is susceptible to rupture by the impact of high-pressure blood flow.
Case: A 350-year-old female presented to the emergency department due to dizziness and tilt to the right when she woke up in the morning.
The patient has a history of diabetes and hypertension for 10 years.
Upon examination, the patient had a pulse rate of 70 beats/min, a blood pressure of 150/90 mmHg, nystagmus and intermittent speech.
During the straight-line gait examination, the patient had a tendency to fall to the right, and no motor and sensory defects were observed.
What is the most likely vascular occlusion site for the patient? A.
Anterior Cerebral Artery B.
Middle Cerebral Artery C.
Posterior Cerebral Artery D.
Vertebrobasilar Artery System The MRI DWI sequence scan results of this patient are as shown in the figure above, showing a large-area infarction of the right cerebellum.
The vertebral artery and basilar artery supply most of the cerebellum, brainstem, thalamus, and occipital cortex.
The obstruction of the vertebrobasilar artery and its branches causes a higher stroke mortality rate.
The surviving patients often have serious sequelae, including paralysis of the limbs, and comorbidity.
Disorders, difficulty swallowing, or dysphonia.
There are also some vertebrobasilar artery strokes caused by small vessel disease and produce various focal neurological deficits.
The specific symptoms depend on the location of the lesion in the cerebellum and brainstem.
Such patients usually have a better prognosis and are more likely to return to function.
Case: A 460-year-old male was sent to the emergency department due to sudden headache, nausea and vomiting, and subsequently lost consciousness.
The GCS score of the patient was 4/15 at the time of consultation.
The physical examination revealed that the patient had significant neck stiffness, and the bilateral Babinski sign was positive.
The imaging examination results are shown in the figure below.
The treating doctor suspected aneurysmal subarachnoid hemorrhage.
Which of the following is the most likely site of aneurysm formation? A.
The tip of the basilar artery B.
The middle cerebral artery C.
The junction of the anterior communicating artery and the anterior cerebral artery D.
The junction of the posterior communicating artery and the internal carotid artery 80% to 90% of patients with aneurysms are caused by subarachnoid rupture due to aneurysm rupture Hemorrhage from the cavity was discovered.
The severity of bleeding symptoms is related to the location of the aneurysm, the amount of bleeding, and the rapidity of bleeding.
Most patients present with sudden headache and disturbance of consciousness.
When the amount of bleeding is small, symptoms such as headache, neck stiffness, and dizziness may occur; when the amount of bleeding is large, drowsiness, frequent vomiting, convulsions, and coma may occur.
Most congenital aneurysms originate from the circle of Willis or the bifurcation of the middle cerebral artery.
The junction of the anterior communicating artery and the anterior cerebral artery is the most common site.
Case: A 540-year-old female presented with sudden dysphagia, dysphonia, and ataxia.
On physical examination, the patient’s Glasgow Coma Score (GCS) was 15 points, and his speech showed dysarthria with nasal sounds.
In addition, the patient also has right Horner syndrome, right IX and X cranial nerve palsy, and has signs of the right cerebellum.
The physical examination of the eye shows the following signs.
What kind of syndrome does the patient’s symptoms and signs match? A.
Weber syndrome B.
Wallenberg syndrome C.
Medial bulbar syndrome D.
Claude syndrome Wallenberg syndrome, also known as lateral dorsal medulla syndrome, is one of the most common types of brainstem infarction.
As shown in the figure, the patient's MRI scan T2-weighted image showed high signal in the right medulla oblongata, consistent with the performance of cerebral infarction.
Typical Wallenberg syndrome has the following 5 typical clinical manifestations: ➤ Damage to the vestibular nucleus-dizziness, nausea, vomiting with nystagmus; ➤ Suspicion of nucleus and damage to the tongue, pharynx, and vagus nerve-choking on drinking water, difficulty swallowing, voice Hoarseness, paralysis of the ipsilateral soft palate, and decreased or disappearance of pharyngeal reflex; ➤ Trigeminal nerve spinal nucleus, trigeminal tract nucleus, spinal thalamic tract damage-cross sensory disturbance, that is, somatic pain and hypothermia on the same side and the opposite side Or disappear; ➤ the sympathetic nerve fibers descending from the reticular structure are damaged—the Horner’s sign on the affected side, that is, the eye fission is small, the pupils are reduced, the eyeball is sunken, and the affected side is sweatless or no sweat; ➤ the spinocerebellar tract and rope body are affected Damage-cerebellar ataxia on the affected side.
The answers to the questions in this article are A, A, D, C, and B in order.
Have you answered all of them correctly? Yimaitong compiled from: Sumaira Nabi, MBBS, FCPS Neurology.
Cerebrovascular Accident: A Stroke of Misfortune.
Medscape Slideshow.
August 9, 2017.
This article will bring you 5 different types of cerebrovascular disease cases, and conduct a simple quiz for the patient's lesion location problem, come and try your skills.
Case: A 180-year-old male with right-handedness, sudden right-handed limb weakness, decreased speech and comprehension, went to see a doctor.
The patient has a history of hypertension and dyslipidemia, and is taking antihypertensive drugs and statins.
Physical examination revealed that the patient was completely aphasia, with central facial paralysis on the right side, hemiplegia on the right side, positive Babinski sign, and loss of feeling on the right side.
What is the most likely blood vessel involved in the patient? A.
Left middle cerebral artery B.
Right middle cerebral artery C.
Left posterior cerebral artery D.
Right posterior cerebral artery As shown in the figure, a large area of low-density shadow can be seen in the blood supply area of the patient’s left middle cerebral artery, midline direction Shift right.
The manifestations of specific neurological deficits in ischemic stroke mainly depend on the blocked arteries and the affected brain volume.
As shown in the figure below, the anterior cerebral artery (ACA) supplies blood to the medial frontal lobe, the posterior cerebral artery (PCA) supplies the occipital lobe, the medial temporal lobe, part of the midbrain and thalamus, and the middle cerebral artery (MCA) is responsible for the parietal and lateral lobe.
Frontal and temporal lobes, insula, internal capsule and basal ganglia area.
The 240-year-old male of the case presented to the doctor due to poor speech, weakness of the right limb, and headache.
He had vomited twice since the onset of illness.
The patient has a history of hypertension for 5 years, but his medication compliance is poor.
The patient was conscious and oriented.
The blood pressure was 170/100 mmHg and the pulse rate was 80 beats/min.
The neurological examination confirmed the patient's right hemiplegia and Babinski sign was positive.
The treating doctor suspected that the patient had cerebral hemorrhage.
What is the most likely bleeding site in this patient? A.
Basal ganglia B.
Thalamus C.
Pons D.
Cerebellum As shown in the picture, hemorrhage can be seen in the basal ganglia area on the left of the patient, and there is no evidence of significant subarachnoid hemorrhage and ventricular dilatation.
Hypertension damages the small perforating arteries in the brain, which mainly supply deep brain structures, including the basal ganglia, internal capsule, thalamus, pons, and cerebellum.
Among them, basal ganglia hemorrhage is the most common in hypertensive intracerebral hemorrhage.
The lenticular artery that supplies this place is emitted from the middle cerebral artery at a right angle and is susceptible to rupture by the impact of high-pressure blood flow.
Case: A 350-year-old female presented to the emergency department due to dizziness and tilt to the right when she woke up in the morning.
The patient has a history of diabetes and hypertension for 10 years.
Upon examination, the patient had a pulse rate of 70 beats/min, a blood pressure of 150/90 mmHg, nystagmus and intermittent speech.
During the straight-line gait examination, the patient had a tendency to fall to the right, and no motor and sensory defects were observed.
What is the most likely vascular occlusion site for the patient? A.
Anterior Cerebral Artery B.
Middle Cerebral Artery C.
Posterior Cerebral Artery D.
Vertebrobasilar Artery System The MRI DWI sequence scan results of this patient are as shown in the figure above, showing a large-area infarction of the right cerebellum.
The vertebral artery and basilar artery supply most of the cerebellum, brainstem, thalamus, and occipital cortex.
The obstruction of the vertebrobasilar artery and its branches causes a higher stroke mortality rate.
The surviving patients often have serious sequelae, including paralysis of the limbs, and comorbidity.
Disorders, difficulty swallowing, or dysphonia.
There are also some vertebrobasilar artery strokes caused by small vessel disease and produce various focal neurological deficits.
The specific symptoms depend on the location of the lesion in the cerebellum and brainstem.
Such patients usually have a better prognosis and are more likely to return to function.
Case: A 460-year-old male was sent to the emergency department due to sudden headache, nausea and vomiting, and subsequently lost consciousness.
The GCS score of the patient was 4/15 at the time of consultation.
The physical examination revealed that the patient had significant neck stiffness, and the bilateral Babinski sign was positive.
The imaging examination results are shown in the figure below.
The treating doctor suspected aneurysmal subarachnoid hemorrhage.
Which of the following is the most likely site of aneurysm formation? A.
The tip of the basilar artery B.
The middle cerebral artery C.
The junction of the anterior communicating artery and the anterior cerebral artery D.
The junction of the posterior communicating artery and the internal carotid artery 80% to 90% of patients with aneurysms are caused by subarachnoid rupture due to aneurysm rupture Hemorrhage from the cavity was discovered.
The severity of bleeding symptoms is related to the location of the aneurysm, the amount of bleeding, and the rapidity of bleeding.
Most patients present with sudden headache and disturbance of consciousness.
When the amount of bleeding is small, symptoms such as headache, neck stiffness, and dizziness may occur; when the amount of bleeding is large, drowsiness, frequent vomiting, convulsions, and coma may occur.
Most congenital aneurysms originate from the circle of Willis or the bifurcation of the middle cerebral artery.
The junction of the anterior communicating artery and the anterior cerebral artery is the most common site.
Case: A 540-year-old female presented with sudden dysphagia, dysphonia, and ataxia.
On physical examination, the patient’s Glasgow Coma Score (GCS) was 15 points, and his speech showed dysarthria with nasal sounds.
In addition, the patient also has right Horner syndrome, right IX and X cranial nerve palsy, and has signs of the right cerebellum.
The physical examination of the eye shows the following signs.
What kind of syndrome does the patient’s symptoms and signs match? A.
Weber syndrome B.
Wallenberg syndrome C.
Medial bulbar syndrome D.
Claude syndrome Wallenberg syndrome, also known as lateral dorsal medulla syndrome, is one of the most common types of brainstem infarction.
As shown in the figure, the patient's MRI scan T2-weighted image showed high signal in the right medulla oblongata, consistent with the performance of cerebral infarction.
Typical Wallenberg syndrome has the following 5 typical clinical manifestations: ➤ Damage to the vestibular nucleus-dizziness, nausea, vomiting with nystagmus; ➤ Suspicion of nucleus and damage to the tongue, pharynx, and vagus nerve-choking on drinking water, difficulty swallowing, voice Hoarseness, paralysis of the ipsilateral soft palate, and decreased or disappearance of pharyngeal reflex; ➤ Trigeminal nerve spinal nucleus, trigeminal tract nucleus, spinal thalamic tract damage-cross sensory disturbance, that is, somatic pain and hypothermia on the same side and the opposite side Or disappear; ➤ the sympathetic nerve fibers descending from the reticular structure are damaged—the Horner’s sign on the affected side, that is, the eye fission is small, the pupils are reduced, the eyeball is sunken, and the affected side is sweatless or no sweat; ➤ the spinocerebellar tract and rope body are affected Damage-cerebellar ataxia on the affected side.
The answers to the questions in this article are A, A, D, C, and B in order.
Have you answered all of them correctly? Yimaitong compiled from: Sumaira Nabi, MBBS, FCPS Neurology.
Cerebrovascular Accident: A Stroke of Misfortune.
Medscape Slideshow.
August 9, 2017.
