A hypeensive individual had a sudden headache and became unconscious within a few minutes. On regaining consciousness, there was complete flaccid hemiplegia with no involvement of upper face, absence of tendon reflexes and a positive Babinski sign. Which one of the following aeries could have ruptured :
Answer is A (Lateral striate branch of middle cerebral): This is a case of hypeensive intracerebral haemorrhage affecting the basal ganglia. Basal ganglia is supplied through medial and lateral striate branches of middle cerebral aery. Lateral striate branch of middle cerebral aery is thus the site of rupture Hypeensive hemorrhage almost always occurs while the patient is awake and sometimes when stressed. It generally presents as severe headache along with abrupt onset of focal neurological deficit. The focal deficit typically worsens steadily and is associated with a diminishing level of consciousness and signs of increased ICP, such as headache & vomiting. The focal neurological signs vary according to the site of the hemorrhage Basal ganglia Thalamus Pons Cerebellum Aeries involved Aeries involved Aeries involved Aeries involved Medial & lateral striate branches of Middle cerebral aery. Perforating branches of posterior cerebral aery Basilar aery Cerebellar aeries - Superior cerebellar - Ant. inferior - Post. Inferior Manifestations Manifestations Manifestations Manifestations * Contralateral hemiparesis * Hemisensory loss involving all modalities * Quadriplegia * Occipital headache is the sentinel sign * Contralateral hemiparesis * Deep coma * Vomiting * Paralysis may worsen sensory loss > motor loss * Decerebrate * Gain ataxia until the affected limbs * Several typical ocular disturbances: rigidity Q * Dizziness or veigo become flaccid or extend - down & inward detion of eyes ** Pinpoint pupil * Ocular changes rigidly - unequal pupils with loss of light reflex that react to light - paresis of conjugate gaze * When haemorrhage is - skew detion with eye opp. * Impairment of - forced detion of eyes large signs of brainstem haemorrhage deted down and reflex eye to opposite side compression may appear - Coma medially - I/L homers syndrome movement on head turning - I/L 6th nerve palsy * Dysahria - Cheyne Stokes respiration - Dilated & fixed ipsilateral pupil - Absence of convergence - Paralysis of veical gaze - Retraction nystagmus * Contralateral pain syndrome (Deferne- (doll's head or occulocephalic maneuver) * Hyperapnea * Dysphagia * Stupor & coma if brainstem compression occurs - Decerebrate rigidity Roussy syndrome) * Hypeension * Aphasics * Hyperhydrosis
Lateral striate branch of middle cerebral
Medial striate branch of anterior cerebral
Posterolateral branch from posterior cerebral
Posterior choroidal branch of posterior cerebral