1. Vascular Board Review
8/17/17

2. A 53 year-old man with PMH HTN, HLD, T2DM presents with acute onset of double vision and weakness. On exam, he is noted to have impaired upgaze and abduction of the left eye and dense hemiparesis of the right face, arm and leg.
Case 1

3. Case 1 Question 1-3: 1. What is the name of this syndrome?
A. von Monakow Syndrome
B. Weber’s syndrome
C. Raymond Syndrome
D. Raymond-Gastan Syndrome
E. Millard-Gubler Syndrome
F. Benedikt Syndrome
2. What area of the brainstem is affected?
A. Dorsal midbrain
B. Ventral midbrain
C. Dorsal pons
D. Ventral pons
E. Medial medulla
F. Ventral medulla
3. What vessel is most likely affected?
A. Paramedian branches of basilar
B. Short circumferential branches of quadrigeminal
C. Lateral branches of the quadrigeminal
D. Superior cerebellar artery branches
E. Thalamogeniculate arteries
Case 1

4. Case 1. Qusestion 1 Answer: B. Question 2 Answer: B.

5. Case 1

6. Case 1.

7. A 64 year old woman with PMH HTN presents with acute onset of double vision and clumsiness in the right hand. On exam, she is noted to have impaired upgaze and adduction of the left eye, ptosis and pupillary dilation that is non-reactive to light on the left and limb ataxia of the right arm with a mild tremor.
Case 2

8. Case 2 Question 4-6: 4. What is the name of this syndrome?
A. von Monakow Syndrome
B. Top of the Basilar Syndrome
C. Nothnagel Syndrome
D. Claude Syndrome
E. Millard-Gubler Syndrome
F. Benedikt Syndrome
5. What area of the brainstem is affected?
A. Dorsal midbrain
B. Ventral midbrain
C. Dorsal pons
D. Ventral pons
E. Medial medulla
F. Ventral medulla
6. What vessel is most likely affected?
A. Paramedian branches of basilar
B. Short circumferential branches of quadrigeminal
C. Lateral branches of the quadrigeminal
D. Superior cerebellar artery branches
E. Thalamogeniculate arteries
Case 2

9. Case 2 Question 4 Answer: D. Question 5 Answer: B.
Question 6 Answer: A.
Case 2

12. An 83 year old woman with PMH HLD, T2DM presents with acute onset of a “twisted” face, weakness of the right arm and leg, and double vision.
Case 3

13. Case 3 7. What is the name of this syndrome?
A. von Monakow Syndrome
B. Foix syndrome
C. Foville syndrome
D. Raymond-Gestan Syndrome
E. Millard-Gubler Syndrome
F. Benedikt Syndrome
8. What area of the brainstem is affected?
A. Dorsal midbrain
B. Ventral midbrain
C. Dorsal pons
D. Ventral pons
E. Lateral pons
F. Medial pons
9. What vessel is most likely affected?
A. Paramedian branches of basilar and short circumferential branches of quadrigeminal
B. Basilar perforating branches
C. Circumferential arteries of basilar
D. PICA
E. AICA
Case 3

14. Case 3 Answer Question 7: E. Answer Question 8: D.
Answer Question 9: C.
Case 3

17. An 54 year old man with severe hypertension presents with acute onset of right arm and leg weakness and numbness of the left arm and leg and trouble swallowing with slurred speech. On exam, she has right arm and leg plegia, L tongue deviation and loss of left vibration and propioception.
Case 4

18. Case 4 Question : 10. What is the name of this syndrome?
A. von Monakow Syndrome
B. Top of the Basilar Syndrome
C. Nothnagel Syndrome
D. Dejerine Syndrome
E. Dejerine-Roussy Syndrome
F. Babinski-Nageotte Syndrome
11. What area of the brainstem is affected?
A. Hemimedulla
B. Ventral midbrain
C. Dorsal pons
D. Ventral pons
E. Medial medulla
F. Lateral medulla
12. What vessel is most likely affected?
A. Paramedian branches of basilar
B. ASA branches
C. AICA branches
D. PICA branches
E. Thalamogeniculate arteries
Case 4

19. Answer 10: E
Answer 11: E
Answer 12: B
Case 4

21. A 90 year old man with PMH HTN, T2DM presents with acute onset of right face, arm and leg weakness and numbness, clumsiness of the left hand. On exam, he has hemiparesis on the right, right facial droop, diminished pain/temp sensation on the right and limb ataxia on the left arm and leg.
Case 5

22. Case 5 7. What is the name of this syndrome?
A. von Monakow Syndrome
B. Marie-Foix syndrome
C. Foville syndrome
D. Raymond-Gestan Syndrome
E. Millard-Gubler Syndrome
F. Benedikt Syndrome
8. What area of the brainstem is affected?
A. Dorsal midbrain
B. Ventral midbrain
C. Dorsal pons
D. Ventral pons
E. Lateral pons
F. Medial pons
9. What vessel is most likely affected?
A. Paramedian branches of basilar
B. Branches of anterior spinal artery
C. Circumferential arteries of basilar
D. PICA
E. AICA
Case 5

23. Answers: B, D, C
Case 5

26. A 45 year old woman with severe T2DM, HTN presents with acute onset of double vision and clumsiness of the left hand. She is noted to have impaired up and downgaze with ptosis of the left eye and impaired upgaze in the right eye as well as left-sided limb ataxia.
Case 6

27. Case 5 7. What is the name of this syndrome?
A. von Monakow Syndrome
B. Marie-Foix syndrome
C. Raymond syndrome
D. Raymond-Gestan Syndrome
E. Nothnagel Syndrome
F. Benedikt Syndrome
8. What area of the brainstem is affected?
A. Dorsal midbrain
B. Ventral midbrain
C. Dorsal pons
D. Ventral pons
E. Lateral pons
F. Medial pons
9. What vessel is most likely affected?
A. Paramedian branches of basilar
B. Branches of SCA/quadrigeminal artery
C. Circumferential arteries of basilar
D. PICA
E. AICA
Case 5

28. Answers: E, A, B
Case 6

29. Case 1.

30. A 76 year old woman with PMH HTN, T2DM, HLD presents with acute onset of facial droop on the left and double vision. On exam, she has a left facial droop including the frontalis and diplopia with leftward gaze, with the medial image extinction with left eye closure.
Case 7

31. Case 7 7. What is the name of this syndrome?
A. von Monakow Syndrome
B. Marie-Foix syndrome
C. Foville Syndrome
D. Raymond-Gestan Syndrome
E. Locked-in Syndrome
F. Benedikt Syndrome
8. What area of the brainstem is affected?
A. Dorsal midbrain
B. Ventral midbrain
C. Dorsal pons
D. Ventral pons
E. Lateral pons
F. Medial pons
9. What vessel is most likely affected?
A. Paramedian branches of basilar
B. Branches of SCA/quadrigeminal artery
C. Short circumferential arteries of basilar
D. Long Circumferential arteries of basilar
E. AICA
Case 7

32. Answers: C, C, C
Case 7