Stroke Artery Territories & Aphasia

Question 1

What are the clinical features of an anterior cerebral artery stroke?

Answer 1

Contralateral hemiparesis and sensory loss

of low limbs

Question 2

What are the clinical features of a middle cerebral artery stroke?

Answer 2

• Contralateral hemiparesis and sensory loss of upper limbs and face
  sensory loss
• Contralateral homonymous hemianopia
• ± Aphasia (Broca’s or Wernicke’s) if dominant hemisphere (L if RH)
• ± Contralateral hemispatial neglect

Question 3

What are the clinical features of a posterior cerebral artery stroke?

Answer 3

• Contralateral homonymous hemianopia with macular sparing

- Contralateral loss of pain & temp (thalamic infarction)

Question 4

What are the clinical features of a vertebrobasilar artery stroke?

Answer 4

• Ipsilateral cerebellar signs - DANISH
• Reduced consciousness (brainstem infarction)
• Quadriplegia/hemiplegia (brainstem infarction)

Question 5

What does DANISH stand for?

Answer 5

• Dysdiadochokinesis
• Ataxia
• Nystagmus
• Intention tremor
• Slurred speech
• HYPOtonia

Question 6

What are features of a total anterior circulation stroke?

Answer 6

• Unilateral motor and/or sensory deficit
• Homonymous hemianopia
• Higher cerebral dysfunction

Question 7

What are features of a partial anterior circulation stroke?

Answer 7

2 of:
• Unilateral motor and/or sensory deficit
• Homonymous hemianopia
• Higher cerebral dysfunction

Question 8

What are features of a posterior circulation stroke?

Answer 8

• CN palsy + contralateral motor/sensory deficit
• Bilateral motor/sensory deficit
• Conjugate eye movement disorder
• Cerebellar impairment
• Isolated homonymous hemianopia

Question 9

What are the 5 syndromes of a lacunar stroke?

Answer 9

1) Ataxic hemiparesis
2) Pure motor
3) Pure sensory
4) Sensorimotor
5) Dysarthria/clumsy hand

Question 10

What is a key feature of lacunar strokes?

Answer 10

Cognition/consciousness intact EXCEPT in thalamic strokes

Question 11

What are some features of brainstem infarcts?

Answer 11

• Quadriplegia
• Disturbances of gaze and vision
• Locked-in syndrome

Question 12

What structures are affected in lacunar infarcts?

Answer 12

• Basal ganglia
• Internal capsule
• Thalamus
• Pons

Question 13

What are the 4 types of aphasia?

Answer 13

1) Receptive (Wernicke’s)
2) Expressive (Broca’s)
3) Conduction
4) Global

Question 14

What causes receptive/Wernicke’s aphasia?

Answer 14

Lesion of superior temporal gyrus (temporal lobe) supplied by inferior division of the left MCA

Question 15

What causes expressive/Broca’s aphasia?

Answer 15

Lesion of the inferior frontal gyrus (frontal lobe) supplied by the superior division of the left MCA

Question 16

What causes conduction aphasia?

Answer 16

Stroke affecting arcuate fasciculus - the connection bewteen Wernicke’s and Broca’s area

Question 17

What is global aphasia?

Answer 17

• Large lesion affecting all 3 of the above areas resulting in severe expressive and receptive aphasia
• May still be able to communicate using gestures

Question 18

What are the features of conduction aphasia?

Answer 18

• Speech is fluent but repetition is poor
• Aware of errors they are making
• Comprehension is normal

Question 19

What are the features of Wernicke’s aphasia?

Answer 19

• Lesions result in sentences that make no sense, word substitution and neologisms but speech remains fluent - this area ‘forms’ the speech before ‘sending it’ to Broca’s area
• Comprehension is impaired

Question 20

What are the features of Broca’s aphasia?

Answer 20

• Speech is non-fluent, laboured, and halting

- Comprehension is normal