Stroke sites and associated effects

Question 1

What arteries are affected by a total anterior circulation stroke (TACS)?

Answer 1

Middle and anterior cerebral arteries.

Question 2

What 3 things need to be present for a TACS diagnosis?

Answer 2

1. Unilateral weakness (and/or sensory deficit) of face, arm and leg)
2. Homonymous hemaniopia
3. Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 3

What arteries are affected by a partial anterior circulation stroke (PACS)?

Answer 3

Only part of anterior circulation has been compromised.

Question 4

What 2 things need to be present for a PACS diagnosis?

Answer 4

Two of following:

1. Unilateral weakness (and/or sensory deficit) of face, arm and leg)
2. Homonymous hemaniopia
3. Higher cerebral dysfunction (dysphasia, visuospatial disorder)

NB: higher cerebral dysfunction alone is also classified as PACS

Question 5

What arteries are affected by posterior circulation syndrome (POCS)?

Answer 5

Posterior circulation (eg. cerebellum and brainstem).

Question 6

What needs to be present for a POCS diagnosis?

Answer 6

One of the following:

1. Cranial nerve palsy and a contralateral motor/ sensory deficit
2. Bilateral motor/ sensory deficit
3. Conjugate eye movement disorder (e.g. horizontal gaze palsy)
4. Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
5. Isolated homonymous hemaniopia

Question 7

What arteries are affected by a lacunar stroke (LACS)?

Answer 7

Perforating arteries around the internal capsule, thalamus and basal ganglia - i.e. a subcortical stroke which occurs secondary to small vessel disease - there is no loss of higher cerebral functions e.g. dysphasia.

Question 8

What needs to present for a diagnosis of LACS?

Answer 8

One of the following:

1. Pure sensory stroke
2. Pure motor stroke
3. Sensori-motor stroke
4. Ataxic hemiparesis

Question 9

What effects would you expect of a stroke affecting the anterior cerebral artery?

Answer 9

Contralateral hemiparesis and sensory loss, lower extremity > upper

Question 10

What effects would you expect of a stroke affecting the middle cerebral artery?

Answer 10

Contralateral hemiparesis and sensory loss, upper extremity > lower

Contralateral homonymous hemianopia

Aphasia

Question 11

What effects would you expect of a stroke affecting the posterior cerebral artery?

Answer 11

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

Question 12

What effects would you expect of a stroke affecting branches of the posterior cerebral artery that supply the midbrain (i.e. Weber’s syndrome)?

Answer 12

Ipsilateral CN III palsy

Contralateral weakness of upper and lower extremity

Question 13

What effects would you expect of a stroke affecting branches of the posterior inferior cerebellar artery (i.e. lateral medullary syndrome/ Wallenberg syndrome)?

Answer 13

Ipsilateral: facial pain and temperature loss

Contralateral: limb/torso pain
and temperature loss

Ataxia, nystagmus

Question 14

What effects would you expect of a stroke affecting branches of the anterior inferior cerebellar artery (i.e. lateral pontine syndrome)?

Answer 14

Symptoms are similar to Wallenberg’s (see above), but:

Ipsilateral: facial paralysis and deafness

Question 15

What effects would you expect of a stroke affecting the retinal/ ophthalmic artery?

Answer 15

Ameurosis fugax

Question 16

What effects would you expect of a stroke affecting the basilar artery?

Answer 16

‘Locked-in’ syndrome