Strokes

Question 1

Lacunar stroke

Answer 1

They involve occlusion of a single penetrating branch of a large cerebral artery and affect the internal capsule, thalamus and basal ganglia.

Features
purely motor
most common lacunar syndrome
purely sensory
sensorimotor stroke
ataxic hemiparesis
ipsilateral weakness and limb ataxia that is out of proportion to the motor deficit
dysarthria-clumsy hand syndrome

As a general rule, lacunar syndromes typically lack cortical findings such as aphasia, agnosia, neglect, apraxia, or hemianopsia

Question 2

DDs

Answer 2

A patient having a lacunar stroke would present with either a purely motor, a purely sensory or a mixed motor and sensory deficit
Important for meLess important
A total anterior circulation infarct would present with a unilateral weakness of the face, arm and leg; as well as a homonymous hemianopia and a symptom of higher cerebral dysfunction.

A posterior circulation infarct would present with a cerebellar or brainstem syndrome, or loss of consciousness, or an isolated homonymous hemianopia.

A partial anterior circulation infarct would present with two of: unilateral weakness, homonymous hemianopia and higher cerebral dysfunction.

Question 3

Stroke by anatomy

Answer 3

Anterior cerebral artery:
Contralateral hemiparesis and sensory loss, lower extremity > upper

Middle cerebral artery:
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

Posterior cerebral artery:
Contralateral homonymous hemianopia with macular sparing
Visual agnosia

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain): Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome):
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Anterior inferior cerebellar artery (lateral pontine syndrome):
Symptoms are similar to Wallenberg’s (see above), but:
Ipsilateral: facial paralysis and deafness

Retinal/ophthalmic artery Amaurosis fugax

Basilar artery ‘Locked-in’ syndrome