A 40 yo M hx of HTN, HLD, DM, PVD, who can’t turn left, is not Derek Zoolander, he’s a man having a stroke!  KNOW YOUR STROKE SYNDROMES!!! As we know, this is a favorite topic of the boards, and will time and again be asked on each board/in-service exam. So lets review some basic stroke territories…

Anterior Cerebral Artery
– Contralateral leg > face/arm weakness
– abulia

Middle Cerebral Artery
– Contralateral face and arm > leg weakness
– sensory loss contralateral side
– visual-spatial neglect
– Ipsilateral gaze preference
– If dominant hemisphere –> aphasia, alexia, agraphia, acalculia

Posterior Cerebral Artery
– contralateral homonymous hemianopia (loss of field in same side of both eyes, ie. loss of left visual field in both eyes)
– If thalamic involvement lose sensory to all modalities

Anterior Inferior Cerebellar Artery (Lateral Pontine Syndrome)
– Contralateral hemiparesis and hemisensory loss of pain/temp
– Ipsilateral ataxia

Posterior Inferior Cerebellar Artery (Lateral Medulla/Wallenberg Syndrome)
– Contralateral hemi pain/temp loss
– Ipsilateral facial pain, hemifacial pain/temp loss
– Ataxia, nystagmus, nausea/vomiting, vertigo, Horner’s, dysphagia
– Hiccups
– can also be seen in vertebral artery occlusion in lateral medulla region

Basilar Artery (Pons/Locked-in Syndrome)
– Bilateral progressive quadriplegia, facial weakness
– lateral gaze weakness with sparing of vertical gaze

Vertebral Artery in Medial Medulla
– Contralateral hemibody weakness/loss of vibration/proprioception
– Ipsilateral tongue weakness and/or atrophy




Bilateral Homonymous Hemianopsia

Homonymous Hemianopsia