Transcript Role of Metabotropic Glutamate Receptors in Central

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
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
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
Panhemispheric Infarcts
Medullary infarcts
Anatomy and supply areas:
perforating branches from PICA, AICA, basilar
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 2448hr or present as TIA
– Vertebral artery dissection in 75% of cases
Medullary infarcts
Medullary infarcts
Medullary infarcts
• Symptoms and signs:
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–
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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
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
References
• Stroke Syndromes: Bogousslavsky and Caplan eds.
Cambridge University press 1995
• Introduction to cerebral angiography: A.G. Osborn auth,
Harper and Row publishers, 1980