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Posterior Cerebral Artery

Posterior Cerebral Artery. Symptoms and signs: Postcommunal PCA Ventrolateral thalamus sensory symptoms, usually paresthesias Motor symptoms include mild hemiparesis, clumsiness and ataxia PCA hemispheric infarction: Contralateral homonymous hemianopia (striate cortex, optic radiation)

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Posterior Cerebral Artery

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  1. Posterior Cerebral Artery Symptoms and signs: • Postcommunal PCA • Ventrolateral thalamus • sensory symptoms, usually paresthesias • Motor symptoms include mild hemiparesis, clumsiness and ataxia • PCA hemispheric infarction: • Contralateral homonymous hemianopia (striate cortex, optic radiation) • Macular region is often spared if occipital pole not affected

  2. Posterior Cerebral Artery Symptoms and signs: • Dominant hemisphere infarction: • Alexia without agraphia(splenium of corpus callosum) • Visual agnosia (medial temporal lobe) • Non dominant hemisphere: • Neglect of contralateral visual field • Constructional apraxia

  3. Panhemispheric Infarcts Etiology: • Total or partial anterior circulation occlusion • 17% of strokes Symptoms and signs: • Variété massive de l`hemiplégie (MCA) • Delayed (48-72hr) impaired consciousness

  4. Panhemispheric Infarcts

  5. Medullary infarcts Anatomy and supply areas: perforating branches from PICA, AICA, basilar

  6. Medullary infarcts Lateral medullary infarcts (Wallenberg’s Syndrome) • Etiology: • Infarction of the lateral medulla and cerebellum caused by PICA occlusion • Sudden in 40%, may be progressive over 24-48hr or present as TIA • Vertebral artery dissection in 75% of cases

  7. Medullary infarcts

  8. Medullary infarcts

  9. Medullary infarcts • Symptoms and signs: • Gait ataxia • Vertigo • Ipsilateral limb clumsiness(cerebellar) • Hypoesthesia of contraleral limbs(crossed spinothalamic) and ipsilateral face(uncrossed trigeminal) • Ipsilateral Horner’s • If AICA involved(lateral inferior pons) • Deafness, tinnitus, facial paresis

  10. Lacunar Syndromes • Occlusion of small perforating arteries • 80% of lacunes are silent • Pure motor stroke • Commonest lacunar syndrome • Usually involves antrior part of posterior limb or internal capsule • Can occur also from basis pontis lacune • Pure sensory stroke: • Only 6% of total lacunar strokes • Thalamus or anterior limb of internal capsule

  11. References • Stroke Syndromes: Bogousslavsky and Caplan eds. Cambridge University press 1995 • Introduction to cerebral angiography: A.G. Osborn auth, Harper and Row publishers, 1980

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