Brain Areas Affected by Stroke

What are the areas affected by ACA stroke?

Medial primary motor area, medial primary sensory area, Posteromedial superior frontal gyrus and corpus callosum

Medial Primary Motor Area Weakness

Contralateral LE weakness or paralysis (hemiparesis or hemiplegia)

Medial Primary Sensory Area Weakness

Contralateral sensory loss in LE

Posteromedial superior frontal gyrus Weakness

Apraxia (difficulty with motor planning), lack of motivation, apathy, behavioral changes, urinary incontinence (micturition center affected) and working memory deficits

Corpus Callosum Weakness

Impaired Interhemispheric transfer (Tactile amomia "Cannot name"), difficulty w/ bimanual tasks

Areas affected by MCA stroke?

PMC, Primary sensory cortex, Broca's, Wernicke's, Parietal Association Cortex, Premotor Cortex, Internal Capsule (motor, somatosensation, and optic fibers), FEF and Striatum

PMC Weakness

Contralateral hemiparesis in UE and face

Primary Sensory Cortex Weakness

Loss of Contralateral sensory info from UE and Face

Left Broca's area Weakness

Broca’s (Expressive) Aphasia: Non-fluent, effortful speech, good comprehension, difficulty planning movement of speech

Right Broca's area weakness

Issues w/ non-motor aspects of speech (social cues, analogies, dysprosody, discourse processing)

Wernicke's Area Weakness

Wernicke’s (Receptive) Aphasia: Fluent but nonsensical speech, poor comprehension, inability to determine meaning of speech

Parietal Association Cortex Weakness

Non-dominant hemisphere (right):

Hemispatial neglect (left side of body/space)

Dominant hemisphere (left): ideomotor Apraxia (cannot perform a motor action to command) or constructional apraxia (difficulty appreciating the structure or arrangement of objects by looking at them)

Premotor Cortex Weakness

Difficulty planning movement (Apraxia) and anticipation for externally-driven movements based on sensory input (PMA), along with intuition of self-paced movement based on memory and internal goals (SMA)

Internal Capsule (Posterior Limb, Optic Fibers and Genu) Weakness

Posterior Limb: Contralateral hemiplegia and sensory loss

Genu: Loss of activation of CN Nuclei resulting in loss of facial muscle activation, loss CN V, IX/X and Upper Vll (Bilateral) or Lower Vll and Xll (Contralateral)

Optic Fibers: Superior or inferior quadrantanopia

FEF Weakness

Loss of contralateral voluntary saccades and ipsilateral eye deviation

Striatum Weakness

Hypokinetic (PD) or Hyperkinetic (Huntington's)

Areas affected by PCA Stroke

Primary visual cortex, visual association cortex, VPL of thalamus, sub thalamic nucleus, cerebral peduncle and CN lll

Primary Visual Cortex Weakness

Bilateral: Cortical Blindness

Unilateral: loss of contralateral visual field

Visual Association Cortex Weakness

Dorsal: Optic Ataxia

Ventral: Visual Agnosia and Prospagnosia

Impaired depth perception

VPL of Thalamus Weakness

Relay contralateral sensory loss (spinothalmic, dorsal column) to post central gyrus

Contralateral Thalamic Pain Syndrome (intense burning or dysesthetic pain after initial numbness)

Subthalamic Nucleus Weakness

Part of indirect basal ganglia pathway – inhibits movement (inability for indirect pathway to work resulting in erratic movement, hyperkinetic disorder)

Contralateral Hemiballismus: wild, involuntary flinging movements of contralateral limbs

Cerebral Peduncle Weakness

Contralateral hemiparesis or hemiplegia of face/arm/leg

CN lll Weakness

Ipsilateral ptosis, downward/lateral eye deviation, mydriasis (dilation of pupil), loss of accommodation and diplopia

Areas affected by AICA Stroke?

CN Vll, Cn Vlll, Vestibular nuclei, Middle cerebral pedicle, and spinothalamic tract

AICA is also known for ?

Lateral Pontine Syndrome

CN Vll Weakness

Ipsilateral loss to anterior 2/3 of tongue, function to lacrimal gland, submandibular gland, and sublingual gland and facial paralysis

CN Vlll Weakness

Ipsilateral loss of balance (unsteady position and mvt of head), loss of hearing and tinnitus and impaired VOR

Vesibular Nuclei Weakness

Ipsilateral impaired VOR, VSR, CVR, nystagmus and postural instability

Middle Cerebellar Peduncle Weakness

Ipsilateral ataxia

Spinothalamic Tract

Contralateral side loss of nociception, crude touch, and temperature

Areas affected by PICA Stroke

Spinothalmic, Spinal trigeminal, nucleus ambiguous, Inferior cerebellar peduncle, and sympathetic fibers

PICA stroke is also known as?

Wallenberg Syndrome

Spinal trigeminal weakness

Ipsilateral pain and temperature loss from the face

Nucleus Ambiguus Weakness

Ipsilateral dysphagia, dysarthria, dysphonia, deviated uvula, soft palate hemiparesis

Sympathetic Fibers Weakness

Ipsilateral Horner’s Syndrome:

Ptosis (Upper eyelid droop)

Miosis (constricted pupil)

Vasodilation

Anhidrosis

Inferior Cerebellar Peduncle Weakness

Ipsilateral impaired VOR (poor suppression), VSR, VCR, limb ataxia and nystagmus

Areas affected by Basilar artery stroke?

Corticospinal tracts, corticobulbar tract and ARAS

Basilar artery infarct is also known as ?

"Locked in syndrome" no ARAS involvement

Corticopsinal Tract Weakness

Anterior: Bilateral proximal trunk weakness

Lateral: Bilateral Paralysis (Quadriplegia)

Long Cranial Nerve Weakness

Bilateral facial paralysis, dysphagia, dysarthria

ARAS Weakness

Consciousness disorder