Related Subjects:
|Neurological History taking
|Causes of Stroke
|Ischaemic Stroke
|Subarachnoid Haemorrhage
|Small Vessel Disease
|Vascular Dementia
|Capsular and Pontine Warning Syndromes
|Dementias
|CADASIL
|CARASIL
|Cerebral Arterial Perfusion and Clinical Correlates
|Anterior circulation Brain
|Posterior circulation Brain
|Acute Stroke Assessment (ROSIER&NIHSS)
|Carotid Artery dissection
|Vertebral artery dissection
|Acute Stroke Assessment (ROSIER&NIHSS)
|Atrial Fibrillation
|Atrial Myxoma
|Causes of Stroke
|Ischaemic Stroke
|Cancer and Stroke
|Cerebral Venous thrombosis
|Cardioembolic stroke
|CT Basics for Stroke
|Endocarditis and Stroke
|Haemorrhagic Stroke
|Stroke Thrombolysis
|Hyperacute Stroke Care
|Anatomy and Physiology of the Brain
|Cryptogenic stroke
|Carotid Web
|Anterior / Medial Medullary Infarct (Dejerine Syndrome)
🧠 Vascular Territories of the Brain
🔴 Internal Carotid Artery (ICA)
- Supplies ipsilateral frontal, parietal, temporal, and occipital lobes.
- Clinical: Infarcts often mimic MCA strokes, though ACA territory may be spared due to collateral flow via the anterior communicating artery.
👁 Ophthalmic Artery
- Central retinal artery occlusion → sudden monocular blindness.
🔗 Posterior Communicating Artery
- Links anterior & posterior circulation; aneurysms here may compress CN III.
- Contributes to thalamus, hypothalamus, and caudate tail perfusion.
🟡 Anterior Choroidal Artery
- Supplies:
- Posterior limb of internal capsule → contralateral motor/sensory loss.
- Optic tract & lateral geniculate body → homonymous hemianopia.
- Choroid plexus of lateral ventricle, globus pallidus, substantia nigra.
🟥 Anterior Cerebral Artery (ACA)
- Deficits: Contralateral weakness & sensory loss, leg > arm.
- No hemianopia; gaze preference to lesion side.
- Dominant hemisphere → expressive dysphasia, dyspraxia.
- Nondominant hemisphere → neglect, visuospatial deficits.
- Behavioural changes: apathy, abulia, disinhibition.
- Paracentral lobule infarction → urinary incontinence.
🟦 Middle Cerebral Artery (MCA)
- Proximal M1 occlusion: Involves basal ganglia & cortex → severe hemiparesis (arm > leg), sensory loss, hemianopia, gaze palsy, aphasia (D), neglect (ND).
- Distal branches spared lenticulostriates: Cortical signs predominate.
- Superior division: Frontal lobe → contralateral face/arm weakness, gaze paresis, expressive dysphasia (D).
- Inferior division: Parietotemporal cortex → sensory loss, hemianopia, receptive dysphasia (D) or neglect (ND).
- Lenticulostriates: Small penetrating arteries → lacunar infarcts of basal ganglia/internal capsule.
🟣 Posterior Cerebral Artery (PCA)
- Proximal P1 occlusion: Infarcts in thalamus, midbrain, mediobasal temporal lobes, occipital cortex → hemiparesis, sensory loss, hemianopia.
- Distal occlusion: Contralateral homonymous hemianopia ± neglect, prosopagnosia (ND).
- Bilateral PCA occlusion: Cortical blindness with preserved pupillary reflexes (Anton’s syndrome), bilateral thalamic infarction → amnesia.
🟤 Basilar Artery
- Occlusion → headache, vertigo, quadriplegia, seizures, coma.
- Locked-in syndrome: preserved vertical gaze & blinking only.
- Top of the basilar: infarcts of midbrain, thalamus, hypothalamus, temporal & occipital lobes → CN III palsy, vertical gaze palsy, ataxia, memory disturbance.
🌐 Midbrain Syndromes
- Weber: Ipsilateral CN III palsy + contralateral hemiparesis.
- Benedikt: Ipsilateral CN III palsy + contralateral ataxia/tremor (red nucleus).
- Nothnagel: Ipsilateral CN III palsy + cerebellar signs + Horner’s syndrome.
🔵 Pons Syndromes
- Millard–Gubler: Ipsilateral CN VI & VII palsy + contralateral hemiparesis.
- Basilar perforator lesions → “crossed” brainstem signs.
🟢 Medullary Syndromes
- Lateral Medullary (Wallenberg, PICA/Vertebral): Horner’s, IX–X palsy (dysphagia, hoarseness), ipsilateral ataxia, contralateral sensory loss.
- Medial Medullary (ASA): Ipsilateral tongue weakness + contralateral hemiparesis & hemisensory loss.
