Common Ischemic Stroke Syndromes

Question 1

Left cerebral hemisphere

Answer 1

Right hemiparesis: often arm, hand, face > leg, right hemisensory loss, aphasia, in large lesions: conjugate deviation of eyes to the left; right hemianopia or hemi-inattention, when ICA occlusive disease: transient left monocular visual loss

Question 2

Right cerebral hemisphere

Answer 2

left hemiparesis: often arm, hand and face > leg, left hemisensory loss, poor drawing and copying, neglect of the left visual field, in large lesions: conjugate deviation of the eyes to the right, left hemianopia, ICA occlusive disease: transient right mononuclear visual loss

Question 3

Lateral medullary stroke (Wallenberg syndrome)

Answer 3

Usually due to intracranial VA occlusion; ipsilateral facial pain, reduced pain and temperature sensation on the ipsilateral face or both, loss of pain and temp in the contralateral limbs and body, Ipsilateral Horner’s, Nystagmus, Incoordination of the ipsilateral arm, leaning and veering while sitting or walking, with gait ataxia, in deep lesions: dysphagia and hoarseness

Question 4

Bilateral pontine base/medial tegmentum stroke

Answer 4

Usually due to basilar artery occlusion or pontine hemorrhage; quadriparesis, unilateral or bilateral conjugate gaze paresis, sometimes INO or VI nerve palsy, when medial tegmentum: coma

Question 5

Cerebellar infarction

Answer 5

Usually due to PICA, SCA, cerebellar hemorrhage; gait ataxia, dysarthria, ipsilateral arm dysmetria

Question 6

Left PCA territory stroke

Answer 6

right homonymous hemianopia, amnesia, alexia without agraphia when the splenium of the corpus callosum is involved

Question 7

Right PCA territory stroke

Answer 7

left homonymous hemianopia, left-sided visual neglect

Question 8

Pure lacunar motor stroke

Answer 8

weakness of contralateral arm, face and leg without sensory, visual or cognitive or behavioral signs

Question 9

Pure lacunar sensory stroke

Answer 9

paresthesiae of the contralateral body, limbs, and face without motor, visual or cognitive abnormalities

Question 10

Pure lacunar dysarthria-clumsy hand syndrome

Answer 10

slurred speech and clumsiness of the contralateral hand

Question 11

Ataxic hemiparesis

Answer 11

weakness and ataxia of the contralateral limbs, often greater in the leg and foot than in the arm and hand