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Medicine

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Neurology

Question
7 out of 27
 

Lacunar infarcts may manifest all of the following except: (PGI 2011)



A Pure sensory weakness
B Pure motor weakness

C Ataxia paresis
D Dysarthria

E Quadriparesis

Ans. E

Quadriparesis

Lacunar infarction (small vessel stroke)

1). The term lacunar infarction refers to infarction following atherothrombotic or lipohyalinotic occlusion of small arteries (30 to 300 μm) in the brain. Occlusion of such small penetrating arteries are now termed as small vessel strokes.

2). Each of these vessels can occlude by

- Atherothrombotic disease at its origin

- Development of lipohyalinotic thickening

3). Thrombosis of the vessels cause small infarcts referred to as lacunes.

4). Hypertension and age are the principal risk factors.

Extra Edge: - Distinct clinical syndromes associated with lacunar infarcts.

1). Pure motor hemiparesis

a. Most common lacunar syndrome

b. Results from infarction of contralateral internal capsule (may also be seen with infarcts in corona radiate and pons)

c. The face, arm and leg are equally affected

d. There is no sensory loss, homonymous hemianopia, Aphasia or hemineglect

2). Pure sensory stroke

a. Infarction almost always involves the thalamus

b. Sensory loss is present throughout the contralateral side.

c. Sensation is usually decreased for all sensory modalities, and no other neurologic deficits are present.

d. Patient often complains of abnormal spontaneous sensation, such as "pins-and-needles" or skin tightness.

3). Sensorimotor stroke

Infarcts involve both internal capsule and thalamus

4. Ataxic hemiparesis

a. Contralateral weakness and limb ataxia

b. Weakness and ataxia present on the same side with the ataxia usually more severe than the weakness.

c. Most commonly occurs in the pons, the internal capsule or the corona radiata

5). Dysarthria Clumsiness syndrome

a. Prominent dysarthria and ataxia of the upper limb

b. Facial weakness, dysphagia and varying degrees of weakness in the arm and leg

c. Associated with infarction in the internal capsule or the pons.

Important Points:

Blood supply to specific brain areas –

1). Thalamus Q– Branches of post communicating, basilar & PCA.

2). Mid brain Q– Post. cerebral, superior cerebellar, basilar.

3). Pons Q– Basilar, Ant, Inf, & superior cerebellar.

4). Medulla Q– Vertebral, ant & post spinal, Post. inf cerebellar, basilar.

5). Cerebellum Q– Superior cerebellar, ant inferior cerebellar, Post. inf cerebellar

6). Internal capsule Q– Superior half Lenticulostriate branches of MCA.

Inferior half Ant. limb – ACA through Heubner artery

Post. limb à Ant. 1/3 Post. communicating

à Post. 2/3 Ant. choroidal.

Neurology Flashcard List

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