I Can’t Turn Left…


    I Can’t Turn Left…


    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