Stroke Syndromes

MCA stroke Syndromes

• Complete occlusion of MCA
• Contralateral hemiplegia, hemianaesthesia, homonymous hemianopia and gaze to the ipsilateral side
• Global aphasia if dominant side
• Apraxia, neglect, anosognosia if non-dominant
• Superior division of MCA occlusion
• A combination of sensory, motor and fluent (expressive, Brocca’s) aphasia
• Inferior division of MCA occlusion
• Wernike’s (fluent) aphasia with superior quadrantanopia
• Lenticulostriate
• Pure motor or motor-sensory stroke
• Genu – facial weakness
• Arm then leg are affected as ischaemia moves posteriorly

Anterior Cerebral Artery

• Precommunal (A1) – joins Carotid to anterior communicating
• Supplies anterior portion of internal capsule, amygdala, anterior hypothalamus and part of caudate nucleus
• Occlusion of A1 generally well tolerated to flow via communicating artery
• Unilateral congenital atresia of A1 can occur so that occlusion of the contralateral A1 results in bilateral ACA infarction
• Postcommunal (A2) – the ACA after the communicating junction
• Occlusion can result in :
1. Foot and leg paralysis or sensory loss
2. Urinary incontinence
3. Abulia
4. Gait apraxia
5. Dyspraxia of left limbs (corpus callosum)

Posterior Cerebral Artery

• 75% have “normal” anatomy with PCA’s deriving from basilar
• 20% have one PCA deriving from the internal carotid with atria of P1 (the segment between basilar and junction with communicating)
• P1 syndromes
• Subthalamus, thalamus
• Cerebral peduncle and midbrain
• Third nerve palsy plus contralateral ataxia (red nucleus) - (Claude’s syndrome)
• Third nerve palsy plus contralateral hemiplegia (cerebral peduncle) (Weber’s syndrome)
• P2 syndromes
• Medial temporal and occipital lobes
• Transient memory problems can occur
• Visual defects

Thalamus

• Can be affected by PCA infarct, hypertensive haemorrhage or venous infarction
• Sensory deficit (all modalities) – contralateral
• Dominant
• Apahsia (with preserved verbal repetition)
• Non-dominant
• Constructional apraxia or mutism

Medullary Syndromes

• Medial
• Ipsilateral
1. Tongue paralysis (12^th nerve nucleus)
• Contralateral
1. Paralysis of arms and legs (sparing face) – pyramidal tracts, prior to decussation
2. Loss of light touch and proprioception – medial lemniscus
• Lateral
• Usually PICA occlusion
• Ipsilateral
1. Pain, numbness and impaired sensation over half the face – 5^th nerve
2. Ataxia, falling to side of lesion – probably spinocerebellar tract and part or cerebellum
3. Nystagmus, diplopia, vertigo – vestibular nucleus
4. Horner’s syndrome – descending sympathetic tracts
5. Dysphagia, hoarsness – 9^th and 10^th nerve fibres
6. Loss of taste – nucleus and tractus solitarius
7. Numbness of ipsilateral arm, trunk or leg – gracile or cuneate nuclei
8. Weakness of face
• Contralateral
1. Impaired pain and temperature sensation – spinothalamic tract