Internal Capsule Stroke | Stanford Medicine 25 | Stanford Medicine

Stanford Medicine 25' Promoting the Culture of Bedside Medicine (/) & (https://www.youtube.com/user/eozdalga) " (https://www.facebook.com/StanfordMedicine25/) # (https://twitter.com/StanfordMed25) Internal Capsule Stroke share ! (mailto:?Subject=Internal Capsule Stroke&Body=http://stanfordmedicine25.stanford.edu/the25/ics.html) " (http://www.facebook.com/sharer.php? s=100&p%5burl%5d=http%3a%2f%2fstanfordmedicine25.stanford.edu%2fthe25%2fics.html) # (https://twitter.com/share?url=http%3a%2f%2fstanfordmedicine25.stanford.edu%2fthe25%2fics.html) + (https://plus.google.com/share?url=http%3a%2f%2fstanfordmedicine25.stanford.edu%2fthe25%2fics.html) % (http://www.linkedin.com/shareArticle? mini=true&url=http%3a%2f%2fstanfordmedicine25.stanford.edu%2fthe25%2fics.html&title=Internal+Capsule+Stroke) Introduction The internal capsule is a unique location where a large number of motor and sensory fibers travel to and from the cortex. Damage of any kind in this location will cause some relatively unique findings that can allow you to localize the lesions to the internal capule by exam alone. Anatomy Location The internal capsule is one of the subcortical structures of the brain. Subcortical structures: internal capsule, caudate, putamen, globus pallidus, thalamus, brainstem The anterior limb of the internal capsule separates the caudate nucleus and lenticular nucleus The posterior limb separates the thalamus and lenticular nucleus Types of fibers Anterior limb: frontopontine fibers (frontal cortex to pons), thalamocortical fibers (thalamus to frontal lobe) Genu (angle): corticobulbar fibers (cortex to brainstem) Posterior limb: corticospinal fibers (cortex to spine), sensory fibers Blood Supply Anterior limb: mainly fed by the lenticulostriate branches of middle cerebral artery(MCA), less often branches of anterior cerebral artery (ACA) The lenticulostriate arteries are small penetrating blood vessels that supply blood flow to most of the subcortical structures. and/or leg (pure motor stroke) Known as one of the classic types of lacunar infarcts. a pure motor strokeis the result of an infarct in the internal capsule. arm. Upper motor neuron signs . Pure motor stroke caused by an infarct in the internal capsule is the most common lacunar syndrome. Genu: lenticulostriate branches of MCA Posterior limb: lenticulostriate branches of MCA & anterior choroidal artery (AChA) of internal carotid artery Clinical Findings Symptoms and Signs Weakness of the face. The presence of these cortical signs may exclude an internal capsule stroke: gaze preference or gaze deviation expressive or receptive aphasia visual field deficits visual or spatial neglect If any of these signs are present. the cortical leg area is supplied by the ACA and the arm area is supplied by the MCA. Babinski sign. clonus. Looking at the homunculus in the figure above.hyperreflexia. the patient may have a cortical stroke. spasticity Mixed sensorimotor stroke Since both motor and sensory fibers are carried in the internal capsule. trunk and legs and sensory fibers are located) can lead to contralateral weakness and contralateral sensory loss If a patient has weakness +/. However. how can you tell whether the stroke is subcortical or cortical? What other symptoms or signs can help you localize the stroke to the internal capsule as opposed to the cortex? A patient who presents with arm and leg weakness may have either a small internal capsule stroke or a large ACA + MCA cortical stroke. not an internal capsule stroke. the injury to the cortices produces other symptoms and signs that not commonly produced by injury to the subcortical areas.sensory deficits. Hoffman present. . a stroke to the posterior limb of the internal capsule (where motor fibers for the arm. . ( Key Learning Points Know the anatomy of the internal capsule Know the clinical findings of an internal capsular stroke Related to Internal Capsule Stroke . html) Deep Tendon Reflexes (/the25/tendon.html) Visit the 25 (/the25/25. Rosacea (/the25/acne. 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