A 71-year-old woman with a history of stroke that happened a month ago complains since then
she has left upper and lower limbs paralyzed and has trouble speaking as well. which is the
single most likely anatomical site to be affected?
Answer Description
Internal capsule
Although it is difficult for this person to talk, the most likely location of the infarction is still the
internal capsule. (which is part of the lacunes)
For the exam, know these three general areas of infarct
Cerebral infarct
• Contralateral sensory loss/hemiplegia, dysphasia, homonymous hemianopia
Answers
Brainstem 0%
Hippocampus 0%
Internal capsule Correct! 0%
Cerebellum 0%
Thalamus Wrong 0
Answer Description
Internal capsule
Although it is difficult for this person to talk, the most likely location of the infarction is still the
internal capsule. (which is part of the lacunes)
For the exam, know these three general areas of infarct
Cerebral infarct
• Contralateral sensory loss/hemiplegia, dysphasia, homonymous hemianopia
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Answers
Brainstem 0%
Hippocampus 0%
Internal capsule Correct! 0%
Cerebellum 0%
Thalamus Wrong 0%
BOOKMARK NEXT QUESTION
11/23/2019 Medrevisions
https://www.medrevisions.com/demo/plab 2/17
Brainstem infarct
• Quadriplegia, locked-in syndrome, vertigo, diplopia
Lacunar infarcts
• Ataxic hemiparesis, pure motor loss, pure sensory loss, sensorimotor loss, dysarthria
Study Notes
Stroke
Overview
In the UK alone there are over 150,000 strokes per year, with over 1.2 million stroke
survivors.
Stroke is the fourth-largest cause of death in the UK and kills twice as many women
Compared with breast cancer each year.
What was previously considered a devastating but untreatable condition is now considered as
more as a ‘brain attack’, this condition which requires an emergency assessment to see if
patients may benefit from new treatments such as thrombolysis.
Image used on license from PathoPic
11/23/2019 Medrevisions
https://www.medrevisions.com/demo/plab 3/17
This is a Pathological specimen showing the results of an ischaemic stroke to the occipitoparietal region of the cerebrum. Note there has been some secondary haemorrhage in the
affected area.
What is a stroke?
A stroke (this also known as cerebrovascular accident,CVA) means a sudden interruption in the
vascular supply of the brain.
Remember that the neural tissue is completely dependent on aerobic metabolism so any
problem with oxygen supply can very quickly lead to irreversible damage.
There are two main types of strokes:
Ischaemic:
These can be further subdivided between into episodes which typically last greater
than 24 hours (termed an ischaemic stroke) and episodes where symptoms and
signs last less than 24 hours (known as transient ischaemic attacks, TIAs,
sometimes termed ‘mini-strokes’ by the patients)
Haemorrhagic
The table below shows the basic differences:
11/23/2019 Medrevisions
https://www.medrevisions.com/demo/plab 4/17
Symptoms and signs
Based on the World Health Organization Stroke is defined as a clinical syndrome consisting of
‘rapidly developing clinical signs of focal (at times global) disturbance of cerebral function,
lasting more than 24 hours or leading to death with no apparent cause other than that of
vascular origin’. In contrast, with a TIA the symptoms and signs resolve within 24 hours.
Features are:
Swallowing problems
11/23/2019 Medrevisions
https://www.medrevisions.com/demo/plab 5/17
Motor weakness
Speech problems (dysphasia)
Visual field defects (homonymous hemianopia)
Balance problems
Cerebral hemisphere infarcts may have the following symptoms:
Contralateral hemiplegia:
Initially flaccid then spastic
Homonymous hemianopia
Dysphasia
Contralateral sensory loss
Brainstem infarction
May result in more severe symptoms which includes quadriplegia and lock-in-syndrome
Lacunar infarcts
It is small infarcts around the basal ganglia, internal capsule, thalamus, and pons
As a result, this may result in pure motor, pure sensory, mixed motor, and sensory signs or
ataxia
Exam Tip
Cerebellar lesion
Presentation:
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
Past pointing