Template:Stroke Syndromes

Revision as of 18:45, 11 July 2015 by Kxl328 (talk | contribs)

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

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)

Superior Cerebellar Artery (SCA)

  • ~2% of all cerebral infarctions[1]
  • Nonspecific symptoms - N/V, dizziness, ataxia, nystagmus (more commonly horizontal)[2]

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[3]:
    • 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
  1. Macdonell RA, Kalnins RM, Donnan GA. Cerebellar infarction: natural history, prognosis, and pathology. Stroke. 18 (5): 849-55.
  2. Lee H, Kim HA. Nystagmus in SCA territory cerebellar infarction: pattern and a possible mechanism. J Neurol Neurosurg Psychiatry. 2013 Apr;84(4):446-51.
  3. Internal Capsule Stroke. Stanford Medicine Guide. http://stanfordmedicine25.stanford.edu/the25/ics.html