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Stroke
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
Concerning strokes and transient ischaemic attacks, which of the following statements are true and which are false? The salvageable area surrounding an infarction is known as the penumbra.Amaurosis fugax is sudden-onset transient monocular blindness due to retinal artery occlusion.The lenticulostriate arteries arise from the anterior cerebral artery.A stroke involving the middle cerebral artery is likely to produce aphasia.During the acute management of a stroke, achieving a normal blood pressure is of importance.
Stroke
Published in Henry J. Woodford, Essential Geriatrics, 2022
Lacunar stroke syndromes (LACS) are usually caused by intrinsic thrombus within small penetrating cerebral blood vessels. The major risk factor for their development is hypertension. They are not associated with any cortical signs (e.g. aphasia, inattention or hemianopia). The lenticulostriate arteries arise from the middle cerebral artery (MCA) and supply blood to the internal capsule. As the motor fibres are tightly packed together in this region, such a lesion will cause a deficit affecting a large body area (seeFigure 10.1). This will either be the face and arm, arm and leg, or face, arm and leg. A more limited deficit is likely to have arisen from a cortical lesion (i.e. not LACS).
Neurorescue During Carotid Stenting: Catheter-Based Techniques and Patient Management
Published in Peter A. Schneider, W. Todd Bohannon, Michael B. Silva, Carotid Interventions, 2004
Peter A. Schneider, Michael B. Silva
The lenticulostriate arteries, as mentioned above, originate from the proximal middle cerebral artery (lateral group) and the anterior cerebral artery (medial group). This is the blood supply to the basal ganglia, deep white matter of the frontal and parietal lobes and the internal and external capsule. The lateral lenticulostriate arteries may arise from the M1 or M2 segments. An occlusion along the proximal MCA where these arteries originate causes severe ischemia and reduces the time available to perform any rescue maneuvers. Lenticulostriate arteries have little or no collateral pathways. If embolization during CAS results in an occlusion of the segment supplying the lenticulostriate arteries, an attempt should be made to recanalize it as soon as possible. Occlusion of the distal MCA or even the very proximal MCA in the setting of good collaterals to the MCA segment perfusing the lenticulostriates may not be as significant as occlusion of the segment that gives rise to the lateral lenticulostriate arteries (40). In general, higher cerebral artery recanalization rates after thrombolysis for stroke are associated with better outcomes (38, 41, 42). However, establishing major artery inflow may not always be helpful and could be harmful if it results in occlusion of the lenticulostriate arteries. A proximal major artery occlusion with good collaterals may be preferable to the potential of breaking up an embolus and passing numerous emboli into smaller distal branches. Therefore, in addition to the location of the lesion, the clinical condition of the patient is essential in determining the importance of an intracranial occlusion.
A rare cause of stroke in young children: minor head trauma associated with mineralising lenticulostriate angiopathy in three patients
Published in Paediatrics and International Child Health, 2022
Kiruthiga Sugumar, Aakash Chandran Chidambaram, Bobbity Deepthi, Sriram Krishnamurthy, C. G. Delhikumar
Acute basal ganglia infarct following minor head trauma is one of the increasingly recognised entities of stroke in children. The most common presentation is acute onset (<6 h) of hemiparesis following a minor fall, with or without other associated neurological features. It is speculated that this distinct clinical entity is owing to mineralised lenticulostriate arteries visible on neuroimaging as basal ganglia calcification [1]. The lenticulostriate arteries are small perforating end arteries which arise from the initial segment of the middle cerebral artery to supply blood to a part of the basal ganglia and internal capsule. These mineralised lenticulostriate arteries are highly susceptible to shearing stress on stiff vessels and occlusion owing to their peculiar anatomical location following even minor head trauma. Computed tomography (CT) of the brain can identify the basal ganglia calcification, supporting the diagnosis. The prognosis is generally good, with acomplete recovery in most patients (47–73%) [1–3]. Unfortunately, a significant minority (25–50%) may have residual weakness [2,3]. Three children with a classical history and neuroimaging consistent with mineralising angiopathy are presented.
Asymmetric lenticulostriate arteries in patients with moyamoya disease presenting with movement disorder: three new cases
Published in Neurological Research, 2020
Jiali Xu, Sijie Li, Gary B. Rajah, Wenbo Zhao, Changhong Ren, Yuchuan Ding, Qian Zhang, Xunming Ji
Moyamoya disease is a disabling disease of the cerebral vasculature, which is characterized by progressive stenosis and occlusion at the bilateral distal internal carotid arteries and(or) their major branches with compensatory development of a hazy collateral network of vessels at the base of the brain [1,2]. MMD patients suffer kinds of symptoms [3,4], and up to 3–6% patients with Moyamoya Disease (MMD) present with different types of movement disorder, such as chorea, dystonia, myoclonus and vascular parkinsonism [5,6]. However, the mechanism of movement disorders associated with MMD is unclear. Many MMD patients with movement disorders previously reported had identifiable contralateral cerebral lesions [7,8], some authors postulated that lesions in contralateral cortical, subcortical especially basal ganglia and subthalamic regions caused by cerebral ischemia or hemorrhage could explain the onset of movement disorders. In addition, it has been reported that contralateral cerebral hypoperfusion may also play a vital role for these patients with movement disorders [8–11]. Furthermore, previous studies also found that the hypertrophied lenticulostriate arteries (LSAs) traversing the basal ganglia shown on angiography or cranial magnetic resonance imaging (MRI) were more significant in MMD patients presenting with movement disorders [12–15]. Although these cases in the above studies had either contralateral lesions or hypoperfusion, they implied a potential effect of hypertrophied LSAs on MMD patients.
Stenosis length of middle cerebral artery and branch atheromatous disease associated infarct
Published in International Journal of Neuroscience, 2018
Jian Wang, Yujie Wang, Zijia Chai, Yue Xin, Jialiang Wang, Jianting Qiu
On the whole, the branch arteries include recurrent artery of Heunber from anterior cerebral artery (ACA), lenticulostriate arteries from middle cerebral artery (MCA) and anterior choroidal artery from internal carotid artery (ICA) in the anterior cerebral circulatory system. Due to the high prevalence and easy identification, the lenticulostriate arteries are the mostly studied. Lenticulostriate arteries originate from the M1 segment of MCA. The M1 segment is classically defined as extending to the insular branches, including the bifurcation of the MCA [12], but it was recently recommended that M1 should be defined as extending from the carotid terminal segment to the first bifurcation of the MCA [13]. Lenticulostriate arteries supply basal ganglia, corona radiate and internal capsule. They stem from MCA separately or in common trunk with others [14,15].