Neuropath - Vascular

• Hippocampus (partial)
• Optic Tract (partial)
• Thalamus (VA, VL, LGN)
• Caudate (tail)
• Red Nucleus
• STN
• SN
• GP (medial)
• Uncus
• Cerebral Peduncle
• Choroid Plexus
• Internal Capsule

Medial frontal lobe and anterior/medial parietal lobe.

Results in contralateral weakness / sensory loss Leg > Arm > Face.

A branch off the Anterior Cerebral Artery.

Supplies the Caudate (head), Internal Capsule (anterior limb), and Putamen (anterior).

Results in contralateral face and arm weakness.

• Superior Division
• Inferior Division
• Lenticulostriate Perforators

Lateral aspect of the cerebral cortex superior to the sylvian fissure.

Lateral aspect of the cerebral cortex inferior to the sylvian fissure.

Are branches off the Middle Cerebral Artery.

Supply the bulk of the Basal Ganglia, Internal Capsule, Caudate, and Corona.

Recurrent Artery of Heubner (Anterior Limb)

Anterior Choroidal Artery (Genu and Posterior Limb)

Lenticulostriates (Posterior Limb)

• Contralateral Hemiplegia
• Contralateral Sensory Loss
• Ipsilateral Gaze Preference
• Global Aphasia (dominant hemisphere)
• Neglect (non-dominant hemisphere)

• Contralateral Hemiplegia (Face + Arm > Leg)
• Contralateral Sensory Loss
• Ipsilateral Gaze Preference
• Broac's Aphasia (dominant hemisphere)
• Neglect (non-dominant hemisphere)

• Wernike's Aphasia (dominant hemisphere)
• Neglect (non-dominant hemisphere)
• Visual Field Cut

Contralateral Hemiparesis

Is the largest branch of the vertebral artery

Supplices the Inferior Cerebellum and Dorsolateral Medulla

Lateral Medullary Syndrome (Wallenberg Syndrome):

Is formed by contributions from both vertebrals.

Supplies the anterior aspect of the spinal cord.

Supply the dorsal aspect of the spinal cord.

• Paramediand and Circumferential Perforators
• Anterior Inferior Cerebellar Artery (AICA)
• Superior Cerebellar Artery (SCA)
• Internal Auditory Artery
• Posterior Cerebral Arteries

• Lateral Inferior Pontine Syndrome:
• Unilateral Deafness

• Caudo-lateral Pontine Tegmentum
• Ventrolateral Cerebellum

Surface of the cerebellum, superior cerebellar peduncle, and the lateral lsuperior pons

• Nystagmus
• Ipsilateral Ataxia
• COntralateral loss of paint and temperature
• Ipsilateral Horner's
• Partial Deafness
• Palatal Myoclonus

• Mesencephalic Artery (supplies the red nuclei, substantia nigra, medial lemnisci, MLF, MCP, and CN III / IV)
• Thalamoperforators (thalamus)
• Thalmogeniculate
• Posterior Choroiral Artery (posterior thalamus, posterior hippocampus, choroid plexus)
• Cortical Branches (inferior temporal, parieto0occipital, and calcarine)

• Four divisions:
• Anterior - Polar / Tuberothalamic Artery --> Abulia and Apathy
• Dorsal - Posterior Choroidal Artery --> Visual Field Deficit
• Paramedian - Posterior Thalamoperforators --> AMS and Vertical Gaze Abnormalities
• Posterolateral - Thalamogeniculate Artery --> Pure Sensory Stroke, Sensorimotor Stroke, or Dejerine Roussy Syndrome

Lesion in the ventral midbrain affecting the cerebral peduncle and CN III leading to an Ipsilateral CN III Palsy and Contralateral Weakness.

*** Weber's Syndrome is assocaited with Weakness ***

Lesion of the Midbrain Tegmentum affecting the Red Nucleus, CN III, and Brachium Conjunctivum resulting in Ipsilateral CN III Palsy and Contralateral Ataxia / Tremor.

*** Clumsy Santa Clause in a Red Suit ***

Leison in the Midbrain Tegmentum affecting the Red Nucleus, CN III, Corticospinal Tract and Brachium Conjunctivum resulting in Ipsilateral CN III Palsy, Contralateral Weakness, Ataxia, and Tremor.

*** Benedickt deserves beneficence because he is clumsy like Claude and weak like Weber ***

Caused by a leison affecting the Dorsal Midbrain and Pretectal Region resulting in Convergence-Retraction Nystagmus, Lid Retraction, Light-near Dissociation, and Impaired Upgaze.

*** Perinaud's involved the Pretectum ***

Caused by a lesion in the Ventral Pons affecting CN VI and VII resulting in an Ipsilateral Lateral Rectus Palsy, Ipsilateral Peripheral VII, and Contralateral Hemiparesis (sparing the face).

*** Millard has 7 letters and Gubler has 6 ***

Caused by a bilateral ventral pontine lesion (e.g. central pointine myolinolysis) resulting in Quadraparesis and Loss of SPeech but can move their eyes vertically and blink.

Caused by occlusion of the AICA affecting CN 5, 7, 8 as well as the Paramedian Pontine Reticular Formation, Spinothalamic Tract, MCP, and Cerebellum resulting in Ipsilateral Decreased Facial Sensation / Facial Paralysis, Nystagmus / Emesis / Vertigo, Deafness / Tinnitus, Gaze Paresis to the side of the lesion, Contralateral Decreased Pain / Temp, Ipsilateral Ataxia.

Caused by infarction in the territory of the oaramedian branches of the vertebral arteries affecting CN's X and XII as well as the Pyramidal Tracts, and Medial Lemniscus resulting in Ipsilateral TOngue Paresis, Contralateral Limb Weakness, and Decreased Virbation / Joint Position.

Caused by infarction in the territory of the PICA affecting CN Vsp, CN VIII, Solitary Nucleus, Nucleus Ambiguus, Spnithalamics Tract, Sympathetics, and Inferior Cerebellar Peduncle resulting in Nausea / Emesis, Impaired Pain and Temperature Sensation, Impaired Gag Ipsilaterally, Horner's Syndrome, Impaired Taste, and Hoarseness.

Pure Motor: Internal Capsule (pl), Brachium Pontis, Corona Radiata

Pure Sensory: Posterolateral Thalamus

Dysarthria-Clumsy Hand: Internal Capsule, Basis Bontis, or Cerebral Peduncle

Ataxia / HemiparesisL Basis Pontis or Internal Capsule

Red Neurons6-24 hours after ischemic stroke

Reactiveastrocytosis about 12 hours after stroke

Reactive astrocytosis in the cerebellum where it is called Bermann's Gliosis about 12 hours after stroke

PMN’s invade the ischemic region in 2-3 days and will remain for months

2days after ischemia, there is vascular proliferation which lacks a proper BBB

That is why this is the peak time for hemorrhage

Old MCA infarction

Wallerian Degeneration from old infarction

Lacunar Infarction in the pons

Lipohyalinosis which is proliferation of the lamina media

Arterial Dissection with blood inside the elastic wall 

RF's: Trauma, Marfan’s, EDS, Fibromuscular, Dysplasia

Lymphocyteswithin the blood vessel wall typical for a vasculitis

Sinovenous Thrombosis of the Superior Sagital Sinus

RF's: Dehydration, Hypercoagulable States, Anemia, Infection

Cortical Hemorrhage

RF's: Amyloid, Coagulopathy, AVMs, HTN

CongoRed stain demonstrating biorefringense typical of amyloid angiopathy

Hypertensive hemorrhages common in the Putamen (65%), Thalamus, Cerebellum, and Pons

Aneurysm at the Circle of Willis

Aneurysm - note the irregular section which lacks a basal lamina (dark line)

Subarachnoid Hemorrhage

Most commonly from a ruptured aneurysm after which trauma is the most common cause

Evaluate with a headt CT followed by LP then angio

Epidural Hematoma

Caused by tearing of the meningeal arteries (e.g. the middle meningeal artery under pterion)

Subdural Hematoma

Caused by tearing of bridging veins and may be seen after traume, low pressure, coagulopathy

• Amyloid
• Angiopathy
• Angioinvasive Fungal
• Infection
• Aneurysm
• Coagulation Disorders
• Cocaine
• Hypertension
• Neoplasms
• Hemorrhagic transformation of an ischemic stroke
• Trauma
• Vascular Malformation
• Anticoagulation / Warfarin

Ischemic

Hemorrhagic

• Embolic
• Thrombotic
• Watershed

Sudden and maximal symptoms at onet

Emboli may arise from the Heart of Proximal Vessels

May be either abrupt in onset or evolve over time

May be due to progressive occlussion of large or small arteries

Major cause is systemic hypoperfusion