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stroke patterns

pure motor hemiplegia

  • lesion in the pons, posterior limb of internal capsule, or cerebral peduncle
  • paralysis of face, arm, and leg without sensory loss
  • no parietal lobe findings

pure sensory hemiparaesthesia

  • lesion usually in the thalamus
  • sensory loss of face, arm, and leg with no hemiplegia or other signs

clumsy hand dysarthria

  • lesion in the pons, anterior limb or genu of internal capsule (eg. lenticulostriate vessels)
  • slurred speech with clumsiness and mild weakness of one arm

crural (leg) paresis and ataxia (ataxic hemiparesis)

  • lesion in the contralateral pons, post. limb of internal capsule, or contralateral thalamus
  • ataxia and weakness of one leg

putaminal intracerebral haemorrhage

  • contralateral hemiplegia
  • eyes deviate to side of the lesion
  • pupils normal size and reactive
  • headache and often a field defect
  • cortical deficits develop as the bleed progresses

thalamic haemorrhage

  • +/- hemiplegia
  • eyes look down and in towards nose
  • impaired upward gaze
  • pupils small and reactive
  • marked sensory loss

pontine haemorrhage

  • usually fatal
  • coma with small pinpoint pupils which react to bright light when viewed through magnifying glass
  • quadriparesis with upgoing plantars
  • no horizontal extraocular movements with passive head turning or use of ice water calorics

middle cerebral artery thrombotic syndrome

  • hemiparesis and cortical sensory loss - both greater in face and arm than in leg
  • aphasia if left brain
  • non-dominant hemisphere findings if right brain
  • homonymous hemianopia
  • conjugate eye deviation to the side of the brain lesion
  • may be partial due to emboli and present as only one of the following:
    • sensorimotor paresis with little aphasia
    • conduction aphasia
    • Wernicke's aphasia without hemiparesis

anterior cerebral artery thrombotic syndrome

  • cortical sensory loss and paralysis of leg
  • incontinence
  • grasp and suck reflexes
  • slowness in mentation with perseveration
  • no hemianopsia or aphasia
  • left limb apraxia

internal cerebral artery occlusion

  • may give combined middle cerebral artery and anterior cerebral artery findings
  • tend to be stuporous or semi-comatose due to the large infarct

posterior cerebral artery thrombotic syndrome

  • homonymous hemianopia
  • little or no paralysis
  • prominent sensory loss
  • no aphasia
  • +/- ability to write but not read and inability to name colors
  • +/- recent memory loss (if hippocampus involved)
  • +/- acute confusional state, especially initially

watershed infarction

  • proximal arm weakness with distal sparing
  • transcortical aphasias

brainstem syndromes

  • never have cortical defects or visual field defects

mid brain infarcts

  • often involve CIII or nucleus and cerebral peduncle resulting in Weber's syndrome:
    • ipsilateral pupil dilatation, ptosis, ophthalmoparesis
    • contralateral hemiplegia

pontine infarcts

medial pontine infarct

  • weakness
  • internuclear ophthalmoplegia or gaze palsy with little sensory loss

lateral, tegmental pontine infarct

  • sensory loss predominates
  • ipsilateral cerebellar signs if lateral pontine

level of pons & cranial nerve involvement

  • upper pons:
    • contralateral facial paralysis sparing forehead
    • contralateral pain and sensory loss in both face and extremities
  • middle pons:
    • trigeminal nerve exits
    • ipsilateral trigeminal nerve lesion ⇒ loss of corneal reflex and facial sensory loss
    • contralateral pain & temperature loss in limbs
  • lower pons:
    • facial nerve exits
    • eighth nerve and nucleus
    • ipsilateral facial nerve (upper and lower) paralysis
    • descending tract of trigeminal nerve lesion resulting in ipsilateral facial pinprick and temperature loss
    • ipsilateral deafness and vertigo (eighth nerve lesion)

lateral medullary syndrome (Wallenberg's syndrome)

  • caused by occlusion of vertebral or post inf cerebellar artery
  • ipsilateral:
  • contralateral:
    • pin prick and temperature loss in arm and leg
  • vertigo, nausea, hiccups, hoarseness, difficulty swallowing & diplopia
stroke_patterns.txt · Last modified: 2015/01/05 12:56 (external edit)