Ischemic stroke history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]


The diagnosis of ischemic stroke largely depends on the history and clinical presentation of patient. Detailed history may give clue about the underlying cause, rule out differential diagnosis and determine the site of infarction. History of sudden onset muscle weakness, slurring of speech, loss of vision, and loss of consciousness may suggest stroke as one of the initial differential diagnosis. This warrants detailed neurological examination and imaging studies to make a definitive diagnosis and rule out other conditions which mimics stroke. Detailed neurological examination may help determine the site of infarction and vessel involved which may suggest the treatment options and prognosis of patient.

History and Symptoms

Past history of hypertension, diabetes mellitus, TIA and amaurosis fugax and prosthetic valves may help determine the underlying cause. The symptoms of an ischemic stroke vary widely depending on the site and blood supply of the area involved:[1][2][3][4][5][6]

Vessel involved Site of infarction History and symptoms
Anterior cerebral artery [1][2]
  • Rare

Superficial branch

Right ACA[1][2]

  • Left sided motor weakness- contralateral lower limb
  • Left sided sensory loss-contralateral lower limb
  • Lack of awareness of the other half of the body-hemineglect [2]
  • Loss of urinary control

Left ACA[1][7]

  • Right sided motor weakness- contralateral lower limb
  • Right sided sensory loss-contralateral lower limb
  • Halting and effortful speech[2]
  • Loss of urinary control

Deep branches (medial lenticulostriate, Heubner's artery)[8][9]

  • Lack of will-power-abulia [8][9][10]
  • Inability to speak, comprehend or pronounce words or objects-aphasia
  • Difficulty articulating words-dysarthria
  • Difficulty remembering things[10]
  • Confusion
  • Patient presents bizarre ideas and have irrelevant talks[8]
Middle cerebral artery[3]
  • Most common site of infarction
  • Right superficial division (RSD)
  • Motor cortex (left head,neck and arm)
  • Sensory cortex (left head, trunk and arm)
  • Left superficial division (LSD)
  • Contralateral right arm and facial weakness
  • Difficulty articulating speech (Broca's aphasia)[11][12][13]
  • Lack of comprehension and understanding of the speech(Wernicke's aphasia)[13]
  • Contralateral visual field defect

Classical lacunar syndromes[16][17][18]

  • Pure motor weakness without sensory loss
  • Pure sensory loss without motor weakness
  • Difficulty maintaining balance
  • Mixed sensorimotor loss
  • Dysarthria clumsy hand syndrome-contralateral motor weakness, sensory loss, difficulty swallowing or articulating speech
Posterior cerebral artery[4][5][6]

Cortical branches[4]'

Right PCA[20]
  • Unilateral headaches
  • Contralateral left visual field defect[4]
  • Patient can see but cannot perceive visual information-Visual agnosia
  • Inability to recognize familiar faces-Prosopagnosia[21]
  • Inability to remember names of objects-Anomic aphasia

Left PCA[20][6][22]

Ganglionic branches[5]

  • Loss of sensations on the contralateral side of the body[24]
  • Contralateral motor weakness of the body[24]
  • Burning and tingling sensations-Thalamic pain syndrome [5]
  • Unilateral flinging movement of arms and leg-Hemiballismus
  • Affected eye moves down and out-occulomotor nerve
  • Increased shaking of hands when trying to perform a task-intention tremors
Vertebrobasilar artery[25]
  • Weber syndrome[26]
  • Third nerve palsy-affected eye moves down and out
  • Contralateral muscle weakness
  • Contralateral sensory loss
Medial pontine syndrome
  • Contralateral muscle weakness
  • Contralateral sensory loss
  • Affected eye may move medially and downwards-abducent nerve involvement

Lateral pontine syndrome

  • Difficulty maintaining balance
  • Vertigo
  • Nausea
  • Vomiting
  • Tremors
  • Thalamus
  • Burning and tingling sensations spontaneously or from a stimulus
  • Occipital cortex
  • Visual field defects
  • Sudden loss of vision

Blood supply of brain


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