Ischemic stroke history and symptoms: Difference between revisions

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==Overview==
==Overview==
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==
==History and Symptoms==
* Detailed history may suggest the underlying cause for ischemic stroke. The symptoms of a stroke are related to the anatomical location of the damage; nature and severity of the symptoms can therefore vary widely
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:<ref name="pmid17895117">{{cite journal| author=Nagaratnam N, Davies D, Chen E| title=Clinical effects of anterior cerebral artery infarction. | journal=J Stroke Cerebrovasc Dis | year= 1998 | volume= 7 | issue= 6 | pages= 391-7 | pmid=17895117 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17895117  }} </ref><ref name="pmid12453077">{{cite journal| author=Kumral E, Bayulkem G, Evyapan D, Yunten N| title=Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings. | journal=Eur J Neurol | year= 2002 | volume= 9 | issue= 6 | pages= 615-24 | pmid=12453077 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12453077  }} </ref><ref name="pmid23139684">{{cite journal| author=Lemieux F, Lanthier S, Chevrier MC, Gioia L, Rouleau I, Cereda C et al.| title=Insular ischemic stroke: clinical presentation and outcome. | journal=Cerebrovasc Dis Extra | year= 2012 | volume= 2 | issue= 1 | pages= 80-7 | pmid=23139684 | doi=10.1159/000343177 | pmc=3492997 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23139684  }} </ref><ref name="pmid10773642">{{cite journal| author=Brandt T, Steinke W, Thie A, Pessin MS, Caplan LR| title=Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature. | journal=Cerebrovasc Dis | year= 2000 | volume= 10 | issue= 3 | pages= 170-82 | pmid=10773642 | doi=16053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10773642  }} </ref><ref name="pmid22377879">{{cite journal| author=Cereda C, Carrera E| title=Posterior cerebral artery territory infarctions. | journal=Front Neurol Neurosci | year= 2012 | volume= 30 | issue=  | pages= 128-31 | pmid=22377879 | doi=10.1159/000333610 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22377879  }} </ref><ref name="pmid10404984">{{cite journal| author=Yamamoto Y, Georgiadis AL, Chang HM, Caplan LR| title=Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry. | journal=Arch Neurol | year= 1999 | volume= 56 | issue= 7 | pages= 824-32 | pmid=10404984 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10404984  }} </ref>
 
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*Left sided motor weakness- contralateral lower limb
*Left sided motor weakness- contralateral lower limb
*Left sided sensory loss-contralateral lower limb
*Left sided sensory loss-contralateral lower limb
*[[Hemineglect]] <ref name="pmid12453077">{{cite journal| author=Kumral E, Bayulkem G, Evyapan D, Yunten N| title=Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings. | journal=Eur J Neurol | year= 2002 | volume= 9 | issue= 6 | pages= 615-24 | pmid=12453077 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12453077  }} </ref>
*Lack of awareness of the other half of the body-[[hemineglect]]<nowiki/> <ref name="pmid12453077">{{cite journal| author=Kumral E, Bayulkem G, Evyapan D, Yunten N| title=Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings. | journal=Eur J Neurol | year= 2002 | volume= 9 | issue= 6 | pages= 615-24 | pmid=12453077 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12453077  }} </ref>
*Behavioral abnormalities
*Loss of urinary control
*[[Urinary incontinence]]
'''Left ACA'''<ref name="pmid17895117">{{cite journal| author=Nagaratnam N, Davies D, Chen E| title=Clinical effects of anterior cerebral artery infarction. | journal=J Stroke Cerebrovasc Dis | year= 1998 | volume= 7 | issue= 6 | pages= 391-7 | pmid=17895117 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17895117  }} </ref><ref name="pmid7356415">{{cite journal| author=Alexander MP, Schmitt MA| title=The aphasia syndrome of stroke in the left anterior cerebral artery territory. | journal=Arch Neurol | year= 1980 | volume= 37 | issue= 2 | pages= 97-100 | pmid=7356415 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7356415  }} </ref>
'''Left ACA'''<ref name="pmid17895117">{{cite journal| author=Nagaratnam N, Davies D, Chen E| title=Clinical effects of anterior cerebral artery infarction. | journal=J Stroke Cerebrovasc Dis | year= 1998 | volume= 7 | issue= 6 | pages= 391-7 | pmid=17895117 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17895117  }} </ref><ref name="pmid7356415">{{cite journal| author=Alexander MP, Schmitt MA| title=The aphasia syndrome of stroke in the left anterior cerebral artery territory. | journal=Arch Neurol | year= 1980 | volume= 37 | issue= 2 | pages= 97-100 | pmid=7356415 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7356415  }} </ref>
*Right sided motor weakness- contralateral lower limb
*Right sided motor weakness- contralateral lower limb
*Right sided sensory loss-contralateral lower limb
*Right sided sensory loss-contralateral lower limb
*Transcortical motor [[aphasia]](non fluent)<ref name="pmid12453077">{{cite journal| author=Kumral E, Bayulkem G, Evyapan D, Yunten N| title=Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings. | journal=Eur J Neurol | year= 2002 | volume= 9 | issue= 6 | pages= 615-24 | pmid=12453077 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12453077 }} </ref><ref name="pmid7356415">{{cite journal| author=Alexander MP, Schmitt MA| title=The aphasia syndrome of stroke in the left anterior cerebral artery territory. | journal=Arch Neurol | year= 1980 | volume= 37 | issue= 2 | pages= 97-100 | pmid=7356415 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7356415 }} </ref>
*Halting and effortful speech<ref name="pmid12453077">{{cite journal| author=Kumral E, Bayulkem G, Evyapan D, Yunten N| title=Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings. | journal=Eur J Neurol | year= 2002 | volume= 9 | issue= 6 | pages= 615-24 | pmid=12453077 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12453077  }} </ref>
*Mutism
*Loss of urinary control
*Contralateral grasp and sucking reflex (physical exam finding)
*Disorganized thinking
*[[Urinary incontinence]]
*Behavioral abnormalities
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'''Deep branches''' (medial lenticulostriate, heubner's artery)<ref name="pmid17940169">{{cite journal| author=den Heijer T, Ruitenberg A, Bakker J, Hertzberger L, Kerkhoff H| title=Neurological picture. Bilateral caudate nucleus infarction associated with variant in circle of Willis. | journal=J Neurol Neurosurg Psychiatry | year= 2007 | volume= 78 | issue= 11 | pages= 1175 | pmid=17940169 | doi=10.1136/jnnp.2006.112656 | pmc=2117617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17940169  }} </ref><ref name="pmid2927642">{{cite journal| author=Mendez MF, Adams NL, Lewandowski KS| title=Neurobehavioral changes associated with caudate lesions. | journal=Neurology | year= 1989 | volume= 39 | issue= 3 | pages= 349-54 | pmid=2927642 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2927642  }} </ref>
'''Deep branches''' (medial lenticulostriate, Heubner's artery)<ref name="pmid17940169">{{cite journal| author=den Heijer T, Ruitenberg A, Bakker J, Hertzberger L, Kerkhoff H| title=Neurological picture. Bilateral caudate nucleus infarction associated with variant in circle of Willis. | journal=J Neurol Neurosurg Psychiatry | year= 2007 | volume= 78 | issue= 11 | pages= 1175 | pmid=17940169 | doi=10.1136/jnnp.2006.112656 | pmc=2117617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17940169  }} </ref><ref name="pmid2927642">{{cite journal| author=Mendez MF, Adams NL, Lewandowski KS| title=Neurobehavioral changes associated with caudate lesions. | journal=Neurology | year= 1989 | volume= 39 | issue= 3 | pages= 349-54 | pmid=2927642 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2927642  }} </ref>
:*Anterior part of [[thalamus]]
:*Anterior part of [[thalamus]]
:*[[Anterior limb of internal capsule]]
:*[[Anterior limb of internal capsule]] (inferior half)
:*Head of [[caudate nucleus]]
:*Head of [[caudate nucleus]]
:*[[Putamen]]
:*[[Putamen]]
:*Rostrum of [[corpus callosum]]
:*[[Septum pellucidum]]
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*[[Abulia]] <ref name="pmid17940169">{{cite journal| author=den Heijer T, Ruitenberg A, Bakker J, Hertzberger L, Kerkhoff H| title=Neurological picture. Bilateral caudate nucleus infarction associated with variant in circle of Willis. | journal=J Neurol Neurosurg Psychiatry | year= 2007 | volume= 78 | issue= 11 | pages= 1175 | pmid=17940169 | doi=10.1136/jnnp.2006.112656 | pmc=2117617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17940169  }} </ref><ref name="pmid2927642">{{cite journal| author=Mendez MF, Adams NL, Lewandowski KS| title=Neurobehavioral changes associated with caudate lesions. | journal=Neurology | year= 1989 | volume= 39 | issue= 3 | pages= 349-54 | pmid=2927642 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2927642  }} </ref><ref name="pmid16510225">{{cite journal| author=Mizuta H, Motomura N| title=Memory dysfunction in caudate infarction caused by Heubner's recurring artery occlusion. | journal=Brain Cogn | year= 2006 | volume= 61 | issue= 2 | pages= 133-8 | pmid=16510225 | doi=10.1016/j.bandc.2005.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16510225  }} </ref>
*Lack of will-power-[[abulia]] <ref name="pmid17940169">{{cite journal| author=den Heijer T, Ruitenberg A, Bakker J, Hertzberger L, Kerkhoff H| title=Neurological picture. Bilateral caudate nucleus infarction associated with variant in circle of Willis. | journal=J Neurol Neurosurg Psychiatry | year= 2007 | volume= 78 | issue= 11 | pages= 1175 | pmid=17940169 | doi=10.1136/jnnp.2006.112656 | pmc=2117617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17940169  }} </ref><ref name="pmid2927642">{{cite journal| author=Mendez MF, Adams NL, Lewandowski KS| title=Neurobehavioral changes associated with caudate lesions. | journal=Neurology | year= 1989 | volume= 39 | issue= 3 | pages= 349-54 | pmid=2927642 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2927642  }} </ref><ref name="pmid16510225">{{cite journal| author=Mizuta H, Motomura N| title=Memory dysfunction in caudate infarction caused by Heubner's recurring artery occlusion. | journal=Brain Cogn | year= 2006 | volume= 61 | issue= 2 | pages= 133-8 | pmid=16510225 | doi=10.1016/j.bandc.2005.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16510225  }} </ref>
*[[Aphasia]]  
*Inability to speak, comprehend or pronounce words or objects-[[aphasia]]  
*[[Dysarhtria|Dysarthria]]
*Difficulty articulating words-[[Dysarhtria|dysarthria]]
*Memory impairment<ref name="pmid16510225">{{cite journal| author=Mizuta H, Motomura N| title=Memory dysfunction in caudate infarction caused by Heubner's recurring artery occlusion. | journal=Brain Cogn | year= 2006 | volume= 61 | issue= 2 | pages= 133-8 | pmid=16510225 | doi=10.1016/j.bandc.2005.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16510225  }} </ref>
*Difficulty remembering things<ref name="pmid16510225">{{cite journal| author=Mizuta H, Motomura N| title=Memory dysfunction in caudate infarction caused by Heubner's recurring artery occlusion. | journal=Brain Cogn | year= 2006 | volume= 61 | issue= 2 | pages= 133-8 | pmid=16510225 | doi=10.1016/j.bandc.2005.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16510225  }} </ref>
*[[Confusion]]
*[[Confusion]]
*[[Confabulation]]<ref name="pmid17940169">{{cite journal| author=den Heijer T, Ruitenberg A, Bakker J, Hertzberger L, Kerkhoff H| title=Neurological picture. Bilateral caudate nucleus infarction associated with variant in circle of Willis. | journal=J Neurol Neurosurg Psychiatry | year= 2007 | volume= 78 | issue= 11 | pages= 1175 | pmid=17940169 | doi=10.1136/jnnp.2006.112656 | pmc=2117617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17940169  }} </ref>
*Patient presents bizarre ideas and have irrelevant talks<ref name="pmid17940169">{{cite journal| author=den Heijer T, Ruitenberg A, Bakker J, Hertzberger L, Kerkhoff H| title=Neurological picture. Bilateral caudate nucleus infarction associated with variant in circle of Willis. | journal=J Neurol Neurosurg Psychiatry | year= 2007 | volume= 78 | issue= 11 | pages= 1175 | pmid=17940169 | doi=10.1136/jnnp.2006.112656 | pmc=2117617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17940169  }} </ref>
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| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" |'''Middle cerebral artery'''
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" |'''Middle cerebral artery'''<ref name="pmid23139684">{{cite journal| author=Lemieux F, Lanthier S, Chevrier MC, Gioia L, Rouleau I, Cereda C et al.| title=Insular ischemic stroke: clinical presentation and outcome. | journal=Cerebrovasc Dis Extra | year= 2012 | volume= 2 | issue= 1 | pages= 80-7 | pmid=23139684 | doi=10.1159/000343177 | pmc=3492997 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23139684  }} </ref>
*Most common site of infarction
*Most common site of infarction
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*Right superficial division (RSD)
*'''Right superficial division (RSD)'''
:*Motor cortex (left head,neck and arm)
:*Motor cortex (left head,neck and arm)
:*Sensory cortex (left head, trunk and arm)
:*Sensory cortex (left head, trunk and arm)
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*Left arm and face weakness
*Contralateral left arm and face weakness
*[[Hemineglect]]
*Patient neglects one half of the body- [[Hemineglect|contralateral Hemineglect]]
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*Left superficial division (LSD)
*'''Left superficial division (LSD)'''
:*[[Broca's area]] (expressive speech area)
:*[[Broca's area]] (expressive speech area)<ref name="pmid25016386">{{cite journal| author=Fridriksson J, Fillmore P, Guo D, Rorden C| title=Chronic Broca's Aphasia Is Caused by Damage to Broca's and Wernicke's Areas. | journal=Cereb Cortex | year= 2015 | volume= 25 | issue= 12 | pages= 4689-96 | pmid=25016386 | doi=10.1093/cercor/bhu152 | pmc=4669036 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25016386  }} </ref><ref name="pmid4062622">{{cite journal| author=Henderson VW| title=Lesion localization in Broca's aphasia. Implications from Broca's aphasia without hemiparesis. | journal=Arch Neurol | year= 1985 | volume= 42 | issue= 12 | pages= 1210-2 | pmid=4062622 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4062622  }} </ref>
:*Wernick's area (receptive speech area)
:*Comprehension of speech is affected[[Wernicke's area]]
:*Motor cortex (right head, neck and arm)
:*[[Motor cortex]] (right head, neck and arm)
:*Sensory cortex (right head, neck and arm)
:*[[Sensory cortex]] (right head, neck and arm)
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*Right arm and facial weakness  
*Contralateral right arm and facial weakness  
*[[Hemineglect]]
*Difficulty articulating speech ([[Broca's aphasia]])<ref name="pmid25016386">{{cite journal| author=Fridriksson J, Fillmore P, Guo D, Rorden C| title=Chronic Broca's Aphasia Is Caused by Damage to Broca's and Wernicke's Areas. | journal=Cereb Cortex | year= 2015 | volume= 25 | issue= 12 | pages= 4689-96 | pmid=25016386 | doi=10.1093/cercor/bhu152 | pmc=4669036 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25016386  }} </ref><ref name="pmid4062622">{{cite journal| author=Henderson VW| title=Lesion localization in Broca's aphasia. Implications from Broca's aphasia without hemiparesis. | journal=Arch Neurol | year= 1985 | volume= 42 | issue= 12 | pages= 1210-2 | pmid=4062622 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4062622  }} </ref><ref name="pmid9577663">{{cite journal| author=Soma Y| title=[Cerebrovascular disorder and the language areas]. | journal=Rinsho Shinkeigaku | year= 1997 | volume= 37 | issue= 12 | pages= 1117-9 | pmid=9577663 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9577663  }} </ref>
*Non fluent aphasia ([[Broca's aphasia]])
*Lack of comprehension and understanding of the speech([[Wernicke's]] aphasia)<ref name="pmid9577663">{{cite journal| author=Soma Y| title=[Cerebrovascular disorder and the language areas]. | journal=Rinsho Shinkeigaku | year= 1997 | volume= 37 | issue= 12 | pages= 1117-9 | pmid=9577663 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9577663  }} </ref>
*Fluent [[aphasia]] (wernick's aphasia)
*Contralateral visual field defect
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*Lenticulostriate branches
*[[Lenticulostriate artery|'''Lenticulostriate''']] '''branches'''<ref name="pmid11843697">{{cite journal| author=Bang OY, Heo JH, Kim JY, Park JH, Huh K| title=Middle cerebral artery stenosis is a major clinical determinant in striatocapsular small, deep infarction. | journal=Arch Neurol | year= 2002 | volume= 59 | issue= 2 | pages= 259-63 | pmid=11843697 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11843697  }} </ref><ref name="pmid1709298">{{cite journal| author=Ghika J, Bogousslavsky J, Regli F| title=Infarcts in the territory of lenticulostriate branches from the middle cerebral artery. Etiological factors and clinical features in 65 cases. | journal=Schweiz Arch Neurol Psychiatr (1985) | year= 1991 | volume= 142 | issue= 1 | pages= 5-18 | pmid=1709298 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1709298  }} </ref>
:*Striatum ([[caudate]] and [[putamen]])
:*Striatum ([[Caudate nucleus|caudate]] and [[putamen]])
:*[[Globus pallidus]]
:*[[Globus pallidus]]
:*[[Internal capsule]] (anterior limb and genu)
:*[[Internal capsule]] (anterior, posterior limb and genu)
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*Pure upper motor weakness  
'''Classical [[lacunar syndromes]]'''<ref name="pmid19210194">{{cite journal| author=Arboix A, Martí-Vilalta JL| title=Lacunar stroke. | journal=Expert Rev Neurother | year= 2009 | volume= 9 | issue= 2 | pages= 179-96 | pmid=19210194 | doi=10.1586/14737175.9.2.179 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19210194  }} </ref><ref name="pmid1565233">{{cite journal| author=Melo TP, Bogousslavsky J, van Melle G, Regli F| title=Pure motor stroke: a reappraisal. | journal=Neurology | year= 1992 | volume= 42 | issue= 4 | pages= 789-95 | pmid=1565233 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1565233  }} </ref><ref name="pmid8256570">{{cite journal| author=Tei H, Uchiyama S, Maruyama S| title=Capsular infarcts: location, size and etiology of pure motor hemiparesis, sensorimotor stroke and ataxic hemiparesis. | journal=Acta Neurol Scand | year= 1993 | volume= 88 | issue= 4 | pages= 264-8 | pmid=8256570 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8256570  }} </ref>
*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
|-
|-
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | '''[[Posterior cerebral artery]]'''
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | '''[[Posterior cerebral artery]]<ref name="pmid10773642">{{cite journal| author=Brandt T, Steinke W, Thie A, Pessin MS, Caplan LR| title=Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature. | journal=Cerebrovasc Dis | year= 2000 | volume= 10 | issue= 3 | pages= 170-82 | pmid=10773642 | doi=16053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10773642  }} </ref><ref name="pmid22377879">{{cite journal| author=Cereda C, Carrera E| title=Posterior cerebral artery territory infarctions. | journal=Front Neurol Neurosci | year= 2012 | volume= 30 | issue=  | pages= 128-31 | pmid=22377879 | doi=10.1159/000333610 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22377879  }} </ref><ref name="pmid10404984">{{cite journal| author=Yamamoto Y, Georgiadis AL, Chang HM, Caplan LR| title=Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry. | journal=Arch Neurol | year= 1999 | volume= 56 | issue= 7 | pages= 824-32 | pmid=10404984 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10404984  }} </ref>'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Superficial branch
'''Cortical branches<ref name="pmid10773642">{{cite journal| author=Brandt T, Steinke W, Thie A, Pessin MS, Caplan LR| title=Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature. | journal=Cerebrovasc Dis | year= 2000 | volume= 10 | issue= 3 | pages= 170-82 | pmid=10773642 | doi=16053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10773642  }} </ref>''''
:*Occipital cortex
:*Occipital cortex<ref name="pmid3606035">{{cite journal| author=Pessin MS, Lathi ES, Cohen MB, Kwan ES, Hedges TR, Caplan LR| title=Clinical features and mechanism of occipital infarction. | journal=Ann Neurol | year= 1987 | volume= 21 | issue= 3 | pages= 290-9 | pmid=3606035 | doi=10.1002/ana.410210311 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3606035  }} </ref>
:*Splenium of [[corpus callosum]]
:*Splenium of [[corpus callosum]]
| style="padding: 5px 5px; background: #F5F5F5;" |
:*[[Hippocampus]]
*[[Homonymous hemianopsia]]
| style="padding: 5px 5px; background: #F5F5F5;" |'''Right PCA<ref name="pmid3742339">{{cite journal| author=Fisher CM| title=The posterior cerebral artery syndrome. | journal=Can J Neurol Sci | year= 1986 | volume= 13 | issue= 3 | pages= 232-9 | pmid=3742339 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3742339  }} </ref>'''
*[[Alexia]] without [[agraphia]].
 
*Unilateral headaches
*Contralateral left visual field defect<ref name="pmid10773642">{{cite journal| author=Brandt T, Steinke W, Thie A, Pessin MS, Caplan LR| title=Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature. | journal=Cerebrovasc Dis | year= 2000 | volume= 10 | issue= 3 | pages= 170-82 | pmid=10773642 | doi=16053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10773642  }} </ref>
*Patient can see but cannot perceive visual information-[[Visual agnosia]]
*Inability to recognize familiar faces-[[Prosopagnosia]]<ref name="pmid7199655">{{cite journal| author=Damasio AR, Damasio H, Van Hoesen GW| title=Prosopagnosia: anatomic basis and behavioral mechanisms. | journal=Neurology | year= 1982 | volume= 32 | issue= 4 | pages= 331-41 | pmid=7199655 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7199655  }} </ref>
*Inability to remember names of objects-[[Anomic aphasia]]
'''Left PCA<ref name="pmid3742339">{{cite journal| author=Fisher CM| title=The posterior cerebral artery syndrome. | journal=Can J Neurol Sci | year= 1986 | volume= 13 | issue= 3 | pages= 232-9 | pmid=3742339 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3742339  }} </ref><ref name="pmid10404984">{{cite journal| author=Yamamoto Y, Georgiadis AL, Chang HM, Caplan LR| title=Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry. | journal=Arch Neurol | year= 1999 | volume= 56 | issue= 7 | pages= 824-32 | pmid=10404984 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10404984  }} </ref><ref name="pmid4434176">{{cite journal| author=Caplan LR, Hedley-Whyte T| title=Cuing and memory dysfunction in alexia without agraphia. A case report. | journal=Brain | year= 1974 | volume= 97 | issue= 2 | pages= 251-62 | pmid=4434176 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4434176  }} </ref>'''
*Inability to read-[[Alexia]] without losing ability to write-[[agraphia]]<ref name="pmid4434176">{{cite journal| author=Caplan LR, Hedley-Whyte T| title=Cuing and memory dysfunction in alexia without agraphia. A case report. | journal=Brain | year= 1974 | volume= 97 | issue= 2 | pages= 251-62 | pmid=4434176 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4434176  }} </ref><ref name="pmid5945970">{{cite journal| author=Geschwind N, Fusillo M| title=Color-naming defects in association with alexia. | journal=Arch Neurol | year= 1966 | volume= 15 | issue= 2 | pages= 137-46 | pmid=5945970 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5945970  }} </ref><ref name="pmid5945970">{{cite journal| author=Geschwind N, Fusillo M| title=Color-naming defects in association with alexia. | journal=Arch Neurol | year= 1966 | volume= 15 | issue= 2 | pages= 137-46 | pmid=5945970 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5945970  }} </ref>
*[[Homonymous hemianopsia|Contralateral right visual field defect]]<ref name="pmid3606035">{{cite journal| author=Pessin MS, Lathi ES, Cohen MB, Kwan ES, Hedges TR, Caplan LR| title=Clinical features and mechanism of occipital infarction. | journal=Ann Neurol | year= 1987 | volume= 21 | issue= 3 | pages= 290-9 | pmid=3606035 | doi=10.1002/ana.410210311 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3606035  }} </ref>
*Inability to do calculations or arithmetic problems-[[Gerstmann syndrome]]<ref name="pmid4434176">{{cite journal| author=Caplan LR, Hedley-Whyte T| title=Cuing and memory dysfunction in alexia without agraphia. A case report. | journal=Brain | year= 1974 | volume= 97 | issue= 2 | pages= 251-62 | pmid=4434176 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4434176  }} </ref>
*Inability to remember names of objects
*Difficulty remembering
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Deep branch
'''Ganglionic branches<ref name="pmid22377879">{{cite journal| author=Cereda C, Carrera E| title=Posterior cerebral artery territory infarctions. | journal=Front Neurol Neurosci | year= 2012 | volume= 30 | issue=  | pages= 128-31 | pmid=22377879 | doi=10.1159/000333610 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22377879  }} </ref>'''
:*[[Thalamus]]  
:*[[Thalamus|'''Thalamus''']] <ref name="pmid22377879">{{cite journal| author=Cereda C, Carrera E| title=Posterior cerebral artery territory infarctions. | journal=Front Neurol Neurosci | year= 2012 | volume= 30 | issue=  | pages= 128-31 | pmid=22377879 | doi=10.1159/000333610 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22377879  }} </ref>
:*Internal capsule (posterior limb)
:*[[Subthalamus|'''Subthalamus''']]  
:*[[Midbrain|'''Midbrain''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Hemisensory loss
*Loss of sensations on the contralateral side of the body<ref name="pmid1640235">{{cite journal| author=Melo TP, Bogousslavsky J| title=Hemiataxia-hypesthesia: a thalamic stroke syndrome. | journal=J Neurol Neurosurg Psychiatry | year= 1992 | volume= 55 | issue= 7 | pages= 581-4 | pmid=1640235 | doi= | pmc=489170 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1640235  }} </ref>
*Hemiparesis  
*[[Hemiparesis|Contralateral]] motor weakness of the body<ref name="pmid1640235">{{cite journal| author=Melo TP, Bogousslavsky J| title=Hemiataxia-hypesthesia: a thalamic stroke syndrome. | journal=J Neurol Neurosurg Psychiatry | year= 1992 | volume= 55 | issue= 7 | pages= 581-4 | pmid=1640235 | doi= | pmc=489170 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1640235  }} </ref>
*Burning and tingling sensations-Thalamic pain syndrome <ref name="pmid22377879">{{cite journal| author=Cereda C, Carrera E| title=Posterior cerebral artery territory infarctions. | journal=Front Neurol Neurosci | year= 2012 | volume= 30 | issue=  | pages= 128-31 | pmid=22377879 | doi=10.1159/000333610 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22377879  }} </ref>
*Unilateral flinging movement of arms and leg-[[Hemiballismus]]
*Affected eye moves down and out-[[Oculomotor nerve palsy|occulomotor nerve]] 
*Increased shaking of hands when trying to perform a task-intention [[Tremor|tremors]]
|-
|-
| rowspan="6" style="padding: 5px 5px; background: #DCDCDC;" | '''Vertebrobasilar artery'''
| rowspan="6" style="padding: 5px 5px; background: #DCDCDC;" | '''Vertebrobasilar artery<ref name="pmid10926972">{{cite journal| author=Caplan L| title=Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. | journal=Stroke | year= 2000 | volume= 31 | issue= 8 | pages= 2011-23 | pmid=10926972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10926972  }} </ref>'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Midbrain]]
*[[Midbrain|'''Midbrain''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Weber syndrome]]
*[[Weber syndrome|'''Weber syndrome''']]<ref name="pmid24778625">{{cite journal| author=Nouh A, Remke J, Ruland S| title=Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management. | journal=Front Neurol | year= 2014 | volume= 5 | issue=  | pages= 30 | pmid=24778625 | doi=10.3389/fneur.2014.00030 | pmc=3985033 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24778625  }}</ref>
*Third nerve palsy-affected eye moves down and out
*Contralateral muscle weakness
*Contralateral sensory loss
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Medulla]]
*[[Medulla|'''Medulla''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Lateral medullary syndrome]]
*[[Lateral medullary syndrome|'''Lateral medullary syndrome''']]<ref name="pmid10926972">{{cite journal| author=Caplan L| title=Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. | journal=Stroke | year= 2000 | volume= 31 | issue= 8 | pages= 2011-23 | pmid=10926972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10926972  }} </ref><ref name="pmid8503798">{{cite journal| author=Sacco RL, Freddo L, Bello JA, Odel JG, Onesti ST, Mohr JP| title=Wallenberg's lateral medullary syndrome. Clinical-magnetic resonance imaging correlations. | journal=Arch Neurol | year= 1993 | volume= 50 | issue= 6 | pages= 609-14 | pmid=8503798 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8503798  }} </ref><ref name="pmid22346215">{{cite journal| author=Shetty SR, Anusha R, Thomas PS, Babu SG| title=Wallenberg's syndrome. | journal=J Neurosci Rural Pract | year= 2012 | volume= 3 | issue= 1 | pages= 100-2 | pmid=22346215 | doi=10.4103/0976-3147.91980 | pmc=3271596 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22346215  }} </ref>
*[[Medial medullary syndrome]]
*Hoarseness of voice-Glossopharngeal nerve
*Pain during swallowing-[[Vagus nerve]]
*Difficulty swallowing-[[Vagus nerve]]
*Choking when drinking or eating
*Loss of pain and temperature sensation on contralateral side of the body
*Ipsilateral loss of pain and temperature sensation on the face
*[[Medial medullary syndrome|'''Medial medullary syndrome''']]<ref name="pmid10926972">{{cite journal| author=Caplan L| title=Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. | journal=Stroke | year= 2000 | volume= 31 | issue= 8 | pages= 2011-23 | pmid=10926972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10926972  }} </ref><ref name="pmid7660396">{{cite journal| author=Kim JS, Kim HG, Chung CS| title=Medial medullary syndrome. Report of 18 new patients and a review of the literature. | journal=Stroke | year= 1995 | volume= 26 | issue= 9 | pages= 1548-52 | pmid=7660396 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7660396  }} </ref><ref name="pmid22787495">{{cite journal| author=Kim K, Lee HS, Jung YH, Kim YD, Nam HS, Nam CM et al.| title=Mechanism of medullary infarction based on arterial territory involvement. | journal=J Clin Neurol | year= 2012 | volume= 8 | issue= 2 | pages= 116-22 | pmid=22787495 | doi=10.3988/jcn.2012.8.2.116 | pmc=3391616 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22787495  }} </ref>
*Tongue deviates to the side of lesion-[[hypoglossal nerve]]
*Weakness of the limbs on the contralateral (opposite) side
*Loss of discriminative touch sensation on the contralateral side
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Pons]]
*[[Pons|'''Pons''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |[[Medial pontine syndrome|'''Medial pontine syndrome''']]
*[[Locked-in syndrome ]]
*Contralateral muscle weakness
*Contralateral sensory loss
*Affected eye may move medially and downwards-[[Abducens nerve|abducent nerve]] involvement
 
[[Lateral pontine syndrome|'''Lateral pontine syndrome''']]
* Weakness of facial muscles-[[facial nerve]] involvement
* Ipsilateral loss of pain and temperature sensation from the face
* [[Nausea]]
* [[Vomiting]]
* [[Vertigo|Sensation of spinning]]  
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Cerebellum]]
*[[Cerebellum]]<ref name="pmid2535662">{{cite journal| author=Amarenco P, Hauw JJ| title=[Anatomy of the cerebellar arteries]. | journal=Rev Neurol (Paris) | year= 1989 | volume= 145 | issue= 4 | pages= 267-76 | pmid=2535662 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2535662  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Difficulty maintaining balance
*Difficulty maintaining balance
Line 126: Line 167:
*Thalamus
*Thalamus
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Burning and tingling sensations spontaneously or from a stimulus
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Occipital cortex
*Occipital cortex
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Visual field defects
* Sudden loss of vision
|-
|-
|}
|}
==Blood supply of brain==
<gallery>
Image:Cortical vascular territories.jpg
Image:Cerebral vascular territories.jpeg
Image:Blood supply of the brain.jpg
</gallery>


==References==
==References==

Latest revision as of 05:49, 30 August 2023

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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]

Overview

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

References

  1. ↑ 1.0 1.1 1.2 1.3 Nagaratnam N, Davies D, Chen E (1998). "Clinical effects of anterior cerebral artery infarction". J Stroke Cerebrovasc Dis. 7 (6): 391–7. PMID 17895117.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Kumral E, Bayulkem G, Evyapan D, Yunten N (2002). "Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings". Eur J Neurol. 9 (6): 615–24. PMID 12453077.
  3. ↑ 3.0 3.1 Lemieux F, Lanthier S, Chevrier MC, Gioia L, Rouleau I, Cereda C; et al. (2012). "Insular ischemic stroke: clinical presentation and outcome". Cerebrovasc Dis Extra. 2 (1): 80–7. doi:10.1159/000343177. PMC 3492997. PMID 23139684.
  4. ↑ 4.0 4.1 4.2 4.3 Brandt T, Steinke W, Thie A, Pessin MS, Caplan LR (2000). "Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature". Cerebrovasc Dis. 10 (3): 170–82. doi:16053 Check |doi= value (help). PMID 10773642.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 Cereda C, Carrera E (2012). "Posterior cerebral artery territory infarctions". Front Neurol Neurosci. 30: 128–31. doi:10.1159/000333610. PMID 22377879.
  6. ↑ 6.0 6.1 6.2 Yamamoto Y, Georgiadis AL, Chang HM, Caplan LR (1999). "Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry". Arch Neurol. 56 (7): 824–32. PMID 10404984.
  7. ↑ Alexander MP, Schmitt MA (1980). "The aphasia syndrome of stroke in the left anterior cerebral artery territory". Arch Neurol. 37 (2): 97–100. PMID 7356415.
  8. ↑ 8.0 8.1 8.2 den Heijer T, Ruitenberg A, Bakker J, Hertzberger L, Kerkhoff H (2007). "Neurological picture. Bilateral caudate nucleus infarction associated with variant in circle of Willis". J Neurol Neurosurg Psychiatry. 78 (11): 1175. doi:10.1136/jnnp.2006.112656. PMC 2117617. PMID 17940169.
  9. ↑ 9.0 9.1 Mendez MF, Adams NL, Lewandowski KS (1989). "Neurobehavioral changes associated with caudate lesions". Neurology. 39 (3): 349–54. PMID 2927642.
  10. ↑ 10.0 10.1 Mizuta H, Motomura N (2006). "Memory dysfunction in caudate infarction caused by Heubner's recurring artery occlusion". Brain Cogn. 61 (2): 133–8. doi:10.1016/j.bandc.2005.11.002. PMID 16510225.
  11. ↑ 11.0 11.1 Fridriksson J, Fillmore P, Guo D, Rorden C (2015). "Chronic Broca's Aphasia Is Caused by Damage to Broca's and Wernicke's Areas". Cereb Cortex. 25 (12): 4689–96. doi:10.1093/cercor/bhu152. PMC 4669036. PMID 25016386.
  12. ↑ 12.0 12.1 Henderson VW (1985). "Lesion localization in Broca's aphasia. Implications from Broca's aphasia without hemiparesis". Arch Neurol. 42 (12): 1210–2. PMID 4062622.
  13. ↑ 13.0 13.1 Soma Y (1997). "[Cerebrovascular disorder and the language areas]". Rinsho Shinkeigaku. 37 (12): 1117–9. PMID 9577663.
  14. ↑ Bang OY, Heo JH, Kim JY, Park JH, Huh K (2002). "Middle cerebral artery stenosis is a major clinical determinant in striatocapsular small, deep infarction". Arch Neurol. 59 (2): 259–63. PMID 11843697.
  15. ↑ Ghika J, Bogousslavsky J, Regli F (1991). "Infarcts in the territory of lenticulostriate branches from the middle cerebral artery. Etiological factors and clinical features in 65 cases". Schweiz Arch Neurol Psychiatr (1985). 142 (1): 5–18. PMID 1709298.
  16. ↑ Arboix A, Martí-Vilalta JL (2009). "Lacunar stroke". Expert Rev Neurother. 9 (2): 179–96. doi:10.1586/14737175.9.2.179. PMID 19210194.
  17. ↑ Melo TP, Bogousslavsky J, van Melle G, Regli F (1992). "Pure motor stroke: a reappraisal". Neurology. 42 (4): 789–95. PMID 1565233.
  18. ↑ Tei H, Uchiyama S, Maruyama S (1993). "Capsular infarcts: location, size and etiology of pure motor hemiparesis, sensorimotor stroke and ataxic hemiparesis". Acta Neurol Scand. 88 (4): 264–8. PMID 8256570.
  19. ↑ 19.0 19.1 Pessin MS, Lathi ES, Cohen MB, Kwan ES, Hedges TR, Caplan LR (1987). "Clinical features and mechanism of occipital infarction". Ann Neurol. 21 (3): 290–9. doi:10.1002/ana.410210311. PMID 3606035.
  20. ↑ 20.0 20.1 Fisher CM (1986). "The posterior cerebral artery syndrome". Can J Neurol Sci. 13 (3): 232–9. PMID 3742339.
  21. ↑ Damasio AR, Damasio H, Van Hoesen GW (1982). "Prosopagnosia: anatomic basis and behavioral mechanisms". Neurology. 32 (4): 331–41. PMID 7199655.
  22. ↑ 22.0 22.1 22.2 Caplan LR, Hedley-Whyte T (1974). "Cuing and memory dysfunction in alexia without agraphia. A case report". Brain. 97 (2): 251–62. PMID 4434176.
  23. ↑ 23.0 23.1 Geschwind N, Fusillo M (1966). "Color-naming defects in association with alexia". Arch Neurol. 15 (2): 137–46. PMID 5945970.
  24. ↑ 24.0 24.1 Melo TP, Bogousslavsky J (1992). "Hemiataxia-hypesthesia: a thalamic stroke syndrome". J Neurol Neurosurg Psychiatry. 55 (7): 581–4. PMC 489170. PMID 1640235.
  25. ↑ 25.0 25.1 25.2 Caplan L (2000). "Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000". Stroke. 31 (8): 2011–23. PMID 10926972.
  26. ↑ Nouh A, Remke J, Ruland S (2014). "Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management". Front Neurol. 5: 30. doi:10.3389/fneur.2014.00030. PMC 3985033. PMID 24778625.
  27. ↑ Sacco RL, Freddo L, Bello JA, Odel JG, Onesti ST, Mohr JP (1993). "Wallenberg's lateral medullary syndrome. Clinical-magnetic resonance imaging correlations". Arch Neurol. 50 (6): 609–14. PMID 8503798.
  28. ↑ Shetty SR, Anusha R, Thomas PS, Babu SG (2012). "Wallenberg's syndrome". J Neurosci Rural Pract. 3 (1): 100–2. doi:10.4103/0976-3147.91980. PMC 3271596. PMID 22346215.
  29. ↑ Kim JS, Kim HG, Chung CS (1995). "Medial medullary syndrome. Report of 18 new patients and a review of the literature". Stroke. 26 (9): 1548–52. PMID 7660396.
  30. ↑ Kim K, Lee HS, Jung YH, Kim YD, Nam HS, Nam CM; et al. (2012). "Mechanism of medullary infarction based on arterial territory involvement". J Clin Neurol. 8 (2): 116–22. doi:10.3988/jcn.2012.8.2.116. PMC 3391616. PMID 22787495.
  31. ↑ Amarenco P, Hauw JJ (1989). "[Anatomy of the cerebellar arteries]". Rev Neurol (Paris). 145 (4): 267–76. PMID 2535662.

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