territories and blood supply

ACA

anterior communicating artery

MCA

middle cerebral artery

PCA

posterior cerebral artery

PICA

posterior inferior cerebellar artery

AICA

anterior inferior cerebellar artery

SCA

superior cerebellar artery

MCA supply

frontal, parietal, temporal lobes

broca and wernicke areas

basal ganglia

ACA supply

medial frontal lobe, medial parietal lobe, corpus callosum, olfactory bulb

lenticulo-striate

caudate nucleus, internal capsule

PCA supply

midbrain, thalamus, occipital lobe, pineal gland, medial temporal lobe

AICA supply

anterior cerebellum, lateral pons

ICA

can produce combined MCA and ACA pattern and present with amaurosis fugax (loss of vision in both eyes)

horner syndrome (ptosis, miosis (pupil constriction) anhidrosis (inability to sweat))

PICA syndrome

Wallenberg syndrome - vertigo, ataxia, sensory abnormalities plus dysarthria, dysphonia, dysphagia

AICA

lateral pontine syndrome (vertigo, ataxia, vomiting, ipsilateral facial paralysis)

cerebellar findings (ipsilateral ataxia, dysmetria)

hearing loss

brainstem and cerebellar findings

locked in syndrome

basilar/ventral brainstem localization with severe motor paralysis despite preserved weakness

transcortical motor aphasia

ACA-MCA watershed region, non-fluent speech with preserved repetition

anomic aphasia

word finding difficulty with otherwise fluent speech and preserved comprehension

PICA supply

cerebellum, superior medulla, choroid plexus, 4th ventricle

SCA supply

superior cerebellum, upper pons

basilar supply

pons, midbrain, both PCA territories

MCA

face/arm > leg weakness

aphasia if L dominant hemisphere

neglect if R hemisphere

gaze preference

visual cut

ACA

leg > arm weakness

executive dysfunction

disinhibition

abulia - lack of will

urinary incontinence

PCA

visual syndromes: contralateral homonymous hemianopia

in dominant hemisphere: alexia, agraphia, propagnosia

bilateral: blindness, amnesia

weber syndrome

parinaud’s syndrome

internal capsule

pure motor or sensorimotor deficits without cortical findings

left MCA

aphasia

left gaze preference

right weakness, facial droop, field cut, numbness

right MCA

R gaze preference

left: neglect, weakness, visual field cut, numbness, anosognosia

broca’s aphasia

expressive language disorder, cannot get words out

wernicke’s aphasia

poor comprehension, word salad

basilar artery

acutely obtunded

ataxia, weakness, diplopia

locked in syndrome

brain stem sx

quadriplegia

coma / agitation

lacunar stroke

pure motor hemiparesis

pure sensory stroke (thalamus)

sensorimotor

ataxic hemiparesis

dysarthria

lacks aphasia, neglect, gaze preference, visual field cut

wallenberg syndrome

lateral medullary pattern with dysphagia, dysphonia (voice disorder), vertigo, ataxia

dysphonia

strained and raspy voice

weber syndrome

midbrain/PCA-associated syndrome

parinaud syndrome

dorsal midbrain/posterior circulation

inability to look up, pupil dysfunction, eyelid abnormalities

transcortical sensory aphasia

PCA-MCA watershed region, fluent but meaningless speech with poor comprehension and preserved repetition

conduction aphasia

severely impaired repetition with fluent speech and intact comprehension

L MCA

global aphasia

severe impairment in all language modalities

L MCA

primary progressive aphasia

neurodegenerative (not a stroke)