2007 UpToDate
Acute stroke syndromes
Artery involved Syndrome Pathophysiology
Anterior cerebral artery
  • Motor and/or sensory deficit (foot >> face, arm)
  • Grasp, sucking reflexes
  • Abulia, paratonic rigidity, gait apraxia
Embolic > atherothrombotic
Middle cerebral artery
  • Dominant hemisphere: aphasia, motor and sensory deficit (face, arm >leg >foot), may be complete hemiplegia if internal capsule involved, homonymous hemianopia.
  • Non-dominant hemisphere: neglect, anosognosia, motor and sensory deficit (face, arm > leg>foot), homonymous hemianopia.
Embolic > atherothrombotic
Posterior cerebral artery
  • Homonymous hemianopia; alexia without agraphia (dominant hemisphere); visual hallucinations, visual perseverations (calcarine cortex); sensory loss, choreoathetosis, spontaneous pain (thalamus); III nerve palsy, paresis of vertical eye movement, motor deficit (cerebral peduncle, midbrain).
Embolic > atherothrombotic
Penetrating vessels
  • Pure motor hemiparesis (classic lacunar syndromes)
  • Pure sensory deficit
  • Pure sensory-motor deficit
  • Hemiparesis, homolateral ataxia
  • Dysarthria/clumsy hand
Small artery (lacunar) infarct
Vertebrobasilar
  • Cranial nerve palsies
  • Crossed sensory deficits
  • Diplopia, dizziness, nausea, vomiting, dysarthria, dysphagia, hiccup
  • Limp and gait ataxia
  • Motory deficit
  • Coma
  • Bilateral signs suggest basilar artery disease.
Embolic = atherothrombotic
Internal carotid artery Progressive or stuttering onset of MCA syndrome, occasionally ACA syndrome as well if insufficient collateral flow. Atherothrombotic > embolic
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