| Vessel occluded | Details |
|---|
| Internal carotid artery |
- Ipsilateral frontal and parietal/occipital and temporal lobes
- Ipsilateral cortical infarction depending on degree of collaterals and
COW flow
- Mimics an MCA infarction or less as ACA may get some collateral supply
across anterior communicating artery
|
| Ophthalmic artery | Transient/fixed Eye Monocular blindness. Exclude Giant cell Arteritis with history and CRP/ESR. Non arteritis then get Doppler. |
| Anterior cerebral artery |
- Contralateral face/arm/leg weak Leg > arm
- C/L face/arm/leg weakness leg > arm
- C/L sensory loss
- No hemianopia
- C/L contralateral gaze palsy
- Expressive Dysphasia (D)
- Visuospatial (ND)
- Dyspraxia (D)
- Neglect (ND) apathy
- Abulia, disinhibition and euphoria.
- Paracentral lobule infarction causes urinary incontinence
|
| Anterior choroidal artery |
- Homonymous field defect
- Motor/sensory loss
|
| Middle cerebral artery | Proximal MCA artery M1
- Infarction of the basal ganglia Internal capsule out towards the cortex.
- Damage worse the more proximal the occlusion as lenticulostriates to basal ganglia affected
- C/L face/arm/leg weakness arm > leg
- C/L sensory loss
- C/L hemianopia
- C/L contralateral gaze palsy
- Dysphasia(D)
- Visuospatial(ND)
- Neglect (ND)
- Dyspraxia (D)
|
| Distal MCA |
- Lenticulostriate arteries may be spared
|
| Superior branch of MCA |
- Frontal lobe infarction
- Face/arm weakness
- Gaze paresis
- Expressive dysphasia (D) and dyspraxia (D)
|
| Posterior inferior branch of MCA |
- Parietal lobe with sensory loss
- Homonymous hemianopia
|
| Posterior cerebral artery |
- Contralateral Hemianopia
- Non-Dominant Side
- Spatial disorientation
- Neglect
- Prosopagnosia
|
| Bilateral PCA occlusion |
- Altitudinal hemianopia, cortical blindness (blindness with preservation of pupillary light response ? Anton?s syndrome)
- Bilateral thalamic stroke causes amnestic symptoms
|
| Basilar Artery |
- Headache, dizziness, vertigo, seizures, coma, quadriplegia
- Locked in syndrome, IIIrd nerve lesion, limb weakness
- Only vertical gaze remains intact and opening and closing eyelids
|
| Top of the basilar artery occlusion
|
- Usually embolic infarction of midbrain, thalamus, hypothalamus and
mediobasal portions of the temporal and occipital lobes
- IIIrd nerve palsy, Vertical gaze palsy, ataxia, sleepiness and even
coma, impaired attention and memory.
|
| | |
| Posterior inferior cerebellar artery(or vertebral artery infarction)
|
Dorsolateral infarction or Wallenburg syndrome
- Horner's syndrome
- IX nerve and X weakness
- Dysphagia and hoarseness
- Nystagmus and Cerebellar ataxia (spinocerebellar tracts) same side
- Contralateral spinothalamic signs and Symptoms
- Altered facial sensation.
|
| Medial medulla |
- Hypoglossal weakness same side
- Contralateral hemisensory Symptoms
- Autonomic disturbance
- Apnoea ?ondine?s curse
|
| Posterior communicating artery | |
| Lateral striate (lenticulostriate) | lacunar type infarcts of basal ganglia and internal capsule as mentioned below |
| Basilar artery occlusion |
- Headache, dizziness, vertigo, seizures, coma, quadriplegia
- Locked in syndrome, IIIrd nerve lesion, limb weakness
- Only vertical gaze remains intact and opening and closing eyelids
- Consider thrombolysis
|
| Top of the basilar artery occlusion |
- Usually embolic infarction of midbrain, thalamus, hypothalamus and mediobasal portions of the temporal and occipital lobes
- IIIrd nerve palsy, Vertical gaze palsy, ataxia, sleepiness and even coma, impaired attention and memory.
|
|
Midbrain Weber syndrome |
- Anterior brainstem infarction
- Contralateral hemiparesis
- Ipsilateral IIIrd nerve palsy
|
|
Benedikt syndrome |
- Paramedian midbrain (red nucleus)
- Contralateral cerebellar dysfunction
- Partial ipsilateral IIIrd nerve nucleus
|
| Nothnagel syndrome |
- Dorsolateral midbrain lesion
- Complete contralateral loss of sensation
- Ipsilateral Horner's syndrome
- Ipsilateral IIIrd nerve palsy
- Ispilateral cerebellar signs
|
| Basilar artery branches to Medial Midbrain |
- ? IIIrd nerve palsy
- C|L hemiparesis and hemiataxia or tremor
|
| P1 segment of PCA supply |
- Lateral Midbrain ? C|L hemisensory loss
- Vertical gaze palsies
|
| Pons - Millard-Gubler syndrome |
- Pontine lesion involving VIth and VII
- Contralateral hemiparesis
- Ipsilateral 6th and 7th
|