Template:Stroke Syndromes

Anterior Circulation

• Blood supply via internal carotid system
• Includes ACA and MCA

Internal Carotid Artery

• Tonic gaze deviation towards lesion
• Global aphasia, dysgraphia, dyslexia, dyscalculia, disorientation (dominant lesion)
• Spatial or visual neglect (non-dominant lesion)

Anterior Cerebral Artery (ACA)

Signs and Symptoms:

• Contralateral sensory and motor symptoms in the lower extremity (sparing hands/face)
• Urinary incontinence
• Left sided lesion: akinetic mutism, transcortical motor aphasia
• Right sided lesion: Confusion, motor hemineglect

Middle Cerebral Artery (MCA)

Signs and Symptoms:

• Hemiparesis, facial plegia, sensory loss contralateral to affected cortex
• Motor deficits found more commonly in face and upper extremity than lower extremity
• Dominant hemisphere involved: aphasia
• Nondominant hemisphere involved: inattention, neglect, dysarthria without aphasia
• Homonymous hemianopsia and gaze preference toward side of infarct may also be seen

Posterior circulation

• Blood supply via the vertebral vertebral artery
• Branches include, Basilar artery, PCA and PICA

Signs and Symptoms:

• Crossed neuro deficits (i.e., ipsilateral CN deficits w/ contralateral motor weakness)
• Multiple, simultaneous complaints are the rule
• 5 Ds: Dizziness (Vertigo), Dysarthria, Dystaxia, Diplopia, Dysphagia
• Isolated events are not attributable to vertebral occlusive disease (e.g. isolated lightheadedness, vertigo, transient ALOC, drop attacks)

Basilar artery

Signs and Symptoms:

• Quadriplegia, coma, locked-in syndrome
• Sparing of vertical eye movements (CN III exits brainstem just above lesion)

Posterior Cerebral Artery (PCA)

Signs and Symptoms:

• Unilateral headache (most common presenting complaint)
• Visual field defects (contralateral homonymous hemianopsia, unilateral blindness)
• Possible macular sparing if MCA unaffected
• Motor function is typically minimally affected

Posterior Inferior Cerebellar Artery (PICA)

Signs and Symptoms:

• Lateral medullary/Wallenberg syndrome: Ipsilateral cerebellar signs, ipsilateral loss of pain/temp of face, ipsilateral Horner's syndrome, contralateral loss of pain/temp over body, dysarthria

Internal Capsule and Lacunar Infarcts

• May present with either lacunar c/l pure motor or c/l pure sensory
• C/l motor plus sensory if large enough or posterior limb of internal capsule
• Clinically to cortical large ACA + MCA stroke - the following signs suggest cortical rather than internal capsule:
  • Gaze preference
  • Visual field defects
  • Aphasia (dominant lesion, MCA)
  • Spatial neglect (non-dominant lesion)