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Acute Stroke Syndromes

Artery involved Syndrome Pathophysiology

Anterior cerebral Motor and/or sensory deficit Embolic > Artery (foot >> face, arm) Grasp atherothrombotic sucking reflexes abulia, paratonic rigidity, gait apraxia.

Middle cerebral artery Dominant hemisphere: aphasia, Embolic > motor and sensory deficit (face, atherothrombotic arm > leg > foot), may be complete hemiplegia if

internal capsule involved, homonymous hemianopia. Non-dominant hemisphere: neglect,anosognosia, motor and sensory deficit(face, arm > leg > foot), homonymous hemianopia. Posterior cerebral Homonymous hemianopia; Alexia Embolic >
artery without agraphia (dominant hemi- atherothrombotic sphere); visual hallucinations, visual perseverations (calcarine cortex); sensory loss, choreoathetosis, spontaneous pain (thalamus);

III nerve palsy, paresis of vertical eye movement, motor deficit (cerebral peduncle,midbrain).

Penetrating vessels Pure motor hemiparesis pure Small artery (lucunar) sensory deficit, pure sensory- infarct motor deficit, hemiparesis, homolateral ataxia dysarthria/clumsy hand. Vertebro basilar Cranial nerve palsies crossed sensory Embolic = deficits diplopia, dizziness, nausea, atherothrombotic vomiting dysarthria, dysphagia, hiccup. limb and gait ataxia motor deficit coma bilateral signs suggest basilar artery disease.

Internal carotid Progressive or stuttering onset of MCA Atherothrombotic > artery syndrome, occasionally aca syndrome embolic as well if insufficient collateral flow.


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