Stroke Syndromes

Question 1

L) MCA Stroke (Usually Dominant)

Answer 1

R) hemiparesis, Global aphasia, R) Hemisensory loss, R) Homonymous hemianopia, dysarthria, Alexia, agraphia, apraxia

Question 2

R) MCA stroke (Usually Non-dominant)

Answer 2

L) hemiparesis, L) neglect, L) Hemisensory loss, L) Homonymous hemianopia, dysarthria, Anosognosia

Question 3

Superior division MCA Stroke

Answer 3

Contralateral

• Paresis UL>LL
• Sensation loss including face
• Hemi-neglect (Nondominant)
• Expressive aphasia (Dominant)

Question 4

Inferior division MCA Stroke

Answer 4

Contralateral

• Homonymous hemianopia (May be upper quadrantanopia)
• Constructional apraxia (Nondominant)
• Receptive aphasia (Dominant)

Question 5

ACA stroke

Answer 5

Dysarthria
Contralateral
- Hemiparesis LL>UL
- Possible sensation changes
- Urinary incontinence
Abulia
Personality changes - Disinhibition, executive dysfunction
Somtimes expressive aphasia/Mutism

Question 6

PCA

Answer 6

Contralateral homonymous hemianopia with macular sparing

Question 7

Lacunar Stroke Syndromes

Answer 7

1. Hemiparesis (Posterior Limb int. capsule)
2. Pure Hemi-sensory (Thalmic)
3. Hemi-Sensorimotor (Junction of IC and thalmus)
4. Ataxic Hemiparesis (corona radiata - MCA/Basilar branches)
5. Clumsy Hand Dysarthria (pons or C.R or I.C)

Question 8

Lateral Medullary Syndrome (Vertebral A/PICA)

Answer 8

Ipsilateral

• Facial sensation loss (pain and temp) (Trigeminal nuc)
• Ataxia (cerebellum)
• Horner Syndrome (Descending symp. chain)
• Nystagmus, vertigo, N+V (Vestibular nuc)
• Hoarse, dysphagia (Nucleus ambiguus - CN 9, 10)

Contralateral
- Hemisensory loss - Pain and temp (spinothalamic tract)

Hiccups

Question 9

Medial Medullary Syndrome (Vertebral A/Anterior Spinal Artery)

Answer 9

Ipsilateral
- Tongue weakness/Atrophy (CN12 Nuc.)

Contralateral

• Hemisensory loss - Vibration, proprioception, touch (Medial lemniscus)
• UL+LL weakness (Pyramidal tract)

Question 10

Lateral Pontine Syndrome (Anterior Inferior Cerebellar Artery, AICA)

Answer 10

Ipsilateral
- Hemi-ataxia (Cerebellar tracts)

Contralateral

• Hemiparesis (Corticospinal tracts)
• Hemisensory loss - Pain and Temp (Spinothalamic Tract)

Question 11

Ventral Pontine Syndrome (Basilar branches)

Answer 11

Ipsilateral
- Lateral Gaze weakness (CN 6)
- +/- Facial paresis (CN 7)
Contralateral
- Hemiparalysis (Pyramidal tract)