SCRN STUDY QUESTIONS AND
SOLUTIONS RESPECTIVELY
A 67yo man with a hx of HTN, DM, HLD, and smoking presents to the ED. CC of persistent dizziness
q1week that has become so severe he now has double vision, N/V. His wife tells you she noticed a L
facial droop and slurring. Pt reports weakness in L arm and leg. He denies HA or SZ. Head CT was
negative for acute bleed. Upon returning to the room he has become increasingly obtunded and difficult
to arouse. You notice he now has a nystagmus and slightly dysconjugate gaze. His exam appears to be
worsening now with R/L extremity weakness in addition to his L hemiparesis. What type of stroke
syndrome are you concerned he may be having?
a. Wallenberg's stroke
b. Dissection of the R internal carotid artery
c. acute basilar artery occlusion
d. Superior cerebellar artery stroke ANSWER : - c
You are assessing a 35yo M who has been in a motor vehicle crash, and during the exam you notice he
has some abnormal eye exam findings and weakness in the R arm and leg (arm more than leg). He has
droopiness of the L eyelid and his pupils are unequal. The L pupil is 3mm in diameter and the right is
5MM. Both pupils are round and reactive to light. Although it is a hot, humid day, he is not sweating
from the heat. What stroke syndrome do you suspect your patient is experiencing?
a. Weber's syndrome
b. Amaurosis fugax
c. Locked-in syndrome
d. Horner's syndrome ANSWER : - d
What is a possible cause of Horner's syndrome?
a. Occlusion of the MCA
b. Dissection of the L ICA
c. Dissection of the R ICA
,d. ACA stroke ANSWER : - b
a patient presents with central retinal artery occlusion. As you evaluate the neuroimaging, you recognize
that the most likely etiology is artery-to-thrombosis from which artery?
a. Basilar artery
b. Middle cerebral artery
c. Posterior inferior cerebellar artery
d. Carotid artery ANSWER : - d
A patient is admitted to the emergency department with acute symptoms of hemiparesis, hemi-sensory
loss, gaze preference, and aphasia. Which vessel do you suspect is involved in the stroke?
a. ACA
b. MCA
c. PCA
d. PICA ANSWER : - b
What cluster of symptoms is consistent with Weber's syndrome?
a. Ipsilateral cranial nerve 3 palsy, contralateral hemiparesis
b. Ipsilateral cranial nerve 4 and 6 palsy, contralateral hemiparesis
c. Contralateral cranial nerve 4 and 6 palsy, ipsilateral hemiparesis
d. ipsilateral cranial nerve 5 paly, ipsilateral ataxia ANSWER : - a
a patient is admitted with symptoms consistent with Weber's syndrome. If the stroke is ischemic, which
arteries would you suspect might have caused the stroke?
a. Carotid artery
b. Middle cerebral artery
, c. Posterior cerebral artery
d. Basilar artery ANSWER : - c
A patient presents with vertical gaze palsy, pupils mid-dilated with light dissociation, and convergence-
retraction nystagmus. This cluster of symptoms is consistent with which of the following symptoms?
a. Weber's syndrome
b. Horner's syndrome
c. Parinaud's syndrome
d. Wallenberg's syndrome ANSWER : - c
Parinaud's syndrome results from which part of the brain?
a. Dorsal midbrain
b. Lateral medulla
c. Ventral pons
d. Posterior inferior cerebellum ANSWER : - a
You are caring for a pt who has had multiple small strokes in the watershed territory between the ACA
and MCA. Which of the following is the most likely etiology for this type of stroke?
a. Embolus of cardiac origin
b. Carotid artery atherosclerosis
c. Vasculitis
d. Severe hypotension ANSWER : - d
Which arteries are occluded in Wallenberg's syndrome?
a. MCA
SOLUTIONS RESPECTIVELY
A 67yo man with a hx of HTN, DM, HLD, and smoking presents to the ED. CC of persistent dizziness
q1week that has become so severe he now has double vision, N/V. His wife tells you she noticed a L
facial droop and slurring. Pt reports weakness in L arm and leg. He denies HA or SZ. Head CT was
negative for acute bleed. Upon returning to the room he has become increasingly obtunded and difficult
to arouse. You notice he now has a nystagmus and slightly dysconjugate gaze. His exam appears to be
worsening now with R/L extremity weakness in addition to his L hemiparesis. What type of stroke
syndrome are you concerned he may be having?
a. Wallenberg's stroke
b. Dissection of the R internal carotid artery
c. acute basilar artery occlusion
d. Superior cerebellar artery stroke ANSWER : - c
You are assessing a 35yo M who has been in a motor vehicle crash, and during the exam you notice he
has some abnormal eye exam findings and weakness in the R arm and leg (arm more than leg). He has
droopiness of the L eyelid and his pupils are unequal. The L pupil is 3mm in diameter and the right is
5MM. Both pupils are round and reactive to light. Although it is a hot, humid day, he is not sweating
from the heat. What stroke syndrome do you suspect your patient is experiencing?
a. Weber's syndrome
b. Amaurosis fugax
c. Locked-in syndrome
d. Horner's syndrome ANSWER : - d
What is a possible cause of Horner's syndrome?
a. Occlusion of the MCA
b. Dissection of the L ICA
c. Dissection of the R ICA
,d. ACA stroke ANSWER : - b
a patient presents with central retinal artery occlusion. As you evaluate the neuroimaging, you recognize
that the most likely etiology is artery-to-thrombosis from which artery?
a. Basilar artery
b. Middle cerebral artery
c. Posterior inferior cerebellar artery
d. Carotid artery ANSWER : - d
A patient is admitted to the emergency department with acute symptoms of hemiparesis, hemi-sensory
loss, gaze preference, and aphasia. Which vessel do you suspect is involved in the stroke?
a. ACA
b. MCA
c. PCA
d. PICA ANSWER : - b
What cluster of symptoms is consistent with Weber's syndrome?
a. Ipsilateral cranial nerve 3 palsy, contralateral hemiparesis
b. Ipsilateral cranial nerve 4 and 6 palsy, contralateral hemiparesis
c. Contralateral cranial nerve 4 and 6 palsy, ipsilateral hemiparesis
d. ipsilateral cranial nerve 5 paly, ipsilateral ataxia ANSWER : - a
a patient is admitted with symptoms consistent with Weber's syndrome. If the stroke is ischemic, which
arteries would you suspect might have caused the stroke?
a. Carotid artery
b. Middle cerebral artery
, c. Posterior cerebral artery
d. Basilar artery ANSWER : - c
A patient presents with vertical gaze palsy, pupils mid-dilated with light dissociation, and convergence-
retraction nystagmus. This cluster of symptoms is consistent with which of the following symptoms?
a. Weber's syndrome
b. Horner's syndrome
c. Parinaud's syndrome
d. Wallenberg's syndrome ANSWER : - c
Parinaud's syndrome results from which part of the brain?
a. Dorsal midbrain
b. Lateral medulla
c. Ventral pons
d. Posterior inferior cerebellum ANSWER : - a
You are caring for a pt who has had multiple small strokes in the watershed territory between the ACA
and MCA. Which of the following is the most likely etiology for this type of stroke?
a. Embolus of cardiac origin
b. Carotid artery atherosclerosis
c. Vasculitis
d. Severe hypotension ANSWER : - d
Which arteries are occluded in Wallenberg's syndrome?
a. MCA
