Stroke syndromes

There are classical presentation of strokes based on the arterial territory that is affected. These are referred to as a 'Stroke Syndromes' and consist of dominant and non-dominant MCA infarction, medial and lateral medullary syndromes, anterior and posterior cerebral artery syndromes, and basilar artery syndromes.

Anterior cerebral artery syndrome

• Contralateral hemiparesis of lower limbs

• Contralateral sensory loss of lower limbs

• Anosmia; olfactory bulb is infarcted

Anterior cerebral artery syndromes tend to be rare as the anterior communicating artery allows collateral blood flow

Alien hand syndrome (anterior corpus callosum or anterior cingulate)

• Independent motor activity of the left limb - usually relatively complex activity, some apparently goal-oriented, and all of it entirely involuntary)

• This happens from infarction of A4 and A5, which are the smallest branches of the anterior cerebral artery which supply the corpus callosum

Gerstmann syndrome : Whole of the dominant MCA

• Agraphia

• Acalculia

• Finger agnosia

• Right-left disorientation

• Contralateral weakness

• Contralateral sensory loss

• Contralateral hemineglect

• Contralateral homonymous hemianopia

• Global aphasia (receptive and expressive)

Inferior division of dominant MCA

• Contralateral homonymous hemianopia or upper quadrant anopsia

• Receptive aphasia - takes out Wernicke's area

Superior division of dominant MCA

• Contralateral weakness (mostly face and arm, not so much leg and foot)

• Lower half of contralateral face is affected

• Contralateral sensory loss

• Contralateral hemineglect

• Expressive aphasia (as it takes out Broca's area)

Whole non-dominant MCA

• Contralateral weakness

• Contralateral sensory loss

• Contralateral hemineglect

• Contralateral homonymous hemianopia

• Construction apraxia (where you lose the ability to reproduce drawing or 3D shapes)

• Spatial disorientiation

Inferior division of non-dominant MCA

• Contralateral homonymous hemianopia or upper quadrant anopsia

• Constructional apraxia

Superior division of non-dominant MCA

• Contralateral weakness (mostly face and arm, not so much leg and foot)

• Mainly the lower half of the contralateral face is affected

• Contralateral sensory loss (including face)

• Contralateral hemineglect

Ataxic hemiparesis

Caused by the small penetrating arteries of the MCA, or the basilar artery, affecting the posterior limb of external capsule and the pons

• Contralateral weakness (more in the leg than the arm)

• Contralateral ataxia

• No facial involvement

Lateral pontine syndrome (Marie-Foix syndrome): Anterior inferior cerebellar artery

• Ipsilateral facial weakness

• Ipsilateral cerebellar ataxia (arm and leg)

• Ipsilateral hearing loss, vertigo and nystagmus (CN VIII is taken out)

• Contralateral weakness (corticospinal tract)

• Contralateral pain and temperature loss (spinothalamic tract)

Lateral medullary syndrome (Wallenberg syndrome): Posterior inferior cerebellar artery (PICA)

• Ipsilateral facial sensory loss

• Ipsilateral Nystagmus

• Ipsilateral Horners

• Loss of gag reflex

• Ipsilaeral ataxia with a tendency to fall to the ipsilateral side

• Contralateral pain and temperature sensory loss in the extremities

• Vertigo, nausea and dysphagia