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, AICA, 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

Anterior Inferior Cerebellar Artery (AICA)

• Lateral inferior pontine syndrome
• Ipsilateral facial paralysis, loss of corneal reflex (CN VII)
• Ipsilateral loss of pain/temp (CN V)
• Nystagmus, N/V, vertigo, ipsilateral hearing loss (CN VIII)
• Ipsilateral limb and gait ataxia
• Ipsilateral Horner syndrome
• Contralateral loss of pain/temp in trunk and extremities (lateral spinothalamic)

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, ipsilateral dysphagia and hoarseness, dysarthria, vertigo/nystagmus, contralateral loss of pain/temp over body
• Also caused by vertebral artery occlusion (most cases)

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)

Anterior Spinal Artery (ASA)

Superior ASA

• Medial medullary syndrome - displays alternating pattern of sidedness of symptoms below
• Contralateral arm/leg weakness and proprioception/vibration
• Tongue deviation towards lesion

Inferior ASA

• ASA syndrome
• Watershed area of hypoperfusion in T4-T8
• B/l pain/temp loss in trunk and extremities (spinothalamic)
• B/l weakness in trunk and extremities (corticospinal)
• Preservation of dorsal columns