STROKECOMPILATION CHARTS

MAJOR CLINICAL SYNDROMES OF THE MCA, ACA, AND PCA TERRITORIES

LOSS OF INFARCT

Left MCA superior division

Left MCA Inferior division

Left MCA deep territory

Left MCA stem

AFFECTED TERRITORY

DEFICITS

• Right face and arm weakness of the upper motor neuron type, and a non fluent, or Broca’s, aphasia. In some cases there may also be some right face and arm cortical-type sensory loss.

• Fluent, or Wernicke’s, aphasia and a right visual field deficit. There may also be some right face and arm cortical-type sensory loss. Motor findings are usually absent, and patients may initially seem confused or crazy, but otherwise intact, unless carefully examined. Some mild right-sided weakness may be present, especially at the onset of symptoms.

• Right pure motor hemiparesis of the upper motor neuron type. Larger infarcts may produce “cortical” deficits as well, such as aphasia.

• Combination of the above, with right hemiplegia, right hemianesthesia, right homonymous hemianopia, and global aphasia. There is often a left gaze preference, especially at the onset, caused by damage to the left hemisphere cortical areas important for driving the eyes to the right.

Rev. 06|15|2016

Functional Neurology Seminars LP © 2016 Dr. Datis Kharrazian and Dr. Brandon Brock

BRAIN STEM CLINICAL SYNDROMES

LOSS OF INFARCT

Right MCA superior division

Right MCA Inferior division

Right MCA deep territory

Right MCA stem

AFFECTED TERRITORY

DEFICITS

• Left face and arm weakness of the upper motor neuron type. Left hemineglect is present to a variable extent. In some cases there may also be some left face and arm cortical-type sensory loss.

• Profount left hemineglect. Left visual field and somatosensory deficits are often present; however, these may be difficult to test convincingly because of the neglect. Motor neglect with decreased voluntary or spontaneous initiation of movements on the left side can also occur. However, even patients with left motor neglect usually have normal strength on the left side, as evidence by occasional spontaneous movements or purposeful withdrawal from pain. Some mild right-sided weakness may be present. There is often a right gaze preference, especially at onset.

• Left pure motor hemiparesis of the upper motor neuron type. Larger infarcts may produce “cortical” deficits as well, such as left hemineglect.

• Combination of the above, with left hemiplegia, left hemianesthesia, left homonymous hemianopia, and profound left hemineglect. There is usually a right gaze preference, especially at the onset, caused by damage to the right hemisphere cortical areas important for driving the eyes to the left.

Rev. 06|15|2016

Functional Neurology Seminars LP © 2016 Dr. Datis Kharrazian and Dr. Brandon Brock

BRAIN STEM CLINICAL SYNDROMES

LOSS OF INFARCT

Left ACA

Right ACA

Left PCA

Right PCA

AFFECTED TERRITORY

DEFICITS

• Right leg weakness of the upper motor neuron type and right leg cortical-type sensory loss. Grasp reflex, frontal lobe behavioral abnormalities, and transcortical aphasia can also be seen. Larger infarcts may cause right hemiplegia.

• Left leg weakness of the upper motor neuron type and left leg coritical-type sensory loss. Grasp reflex, frontal lobe behavioral abnormalities, and left hemineglect can also be seen. Larger infarcts may cause left hemiplegia.

• RIght homonymous hemianopia. Extension to the splenium of the corpus callosum can cause alexia without agraphia. Larger infarcts including the thalamus and internal capsule may cause aphasia, right hemisensory loss and right hemiparesis.

• Left homonymous hemianopia. Larger infarcts including the thalamus and internal capsule may cause left hemisensory loss and left hemiparesis.

Rev. 06|15|2016

Functional Neurology Seminars LP © 2016 Dr. Datis Kharrazian and Dr. Brandon Brock

BRAIN STEM CLINICAL SYNDROMES

NAME

Weber’s syndrome

Benedict’s syndrome

Claude’s syndrome

Nothnagel’s syndrome

Millard-Gubler syndrome

Foville syndrome

AFFECTED TERRITORY

CLINICAL SYMPTOMS (anatomy) • Contralateral hemiparesis (cerebral

peduncle) Ipsilateral CN III palsy (fascicles of CN III)

• Impaired ipsilateral pupillary reflex (CN III) and dilated pupil

• Ipsilateral CN III palsy usually with dilated pupil (CN III fascicles)

• Contralateral involuntary movements (red nucleus, subthalamic nucleus)

• Ipsilateral CN III palsy (CN III fascicles)• Contralateral hemiataxia and dysmetria

(dentatothalamic fibers within the superior cerebellar peduncle)

• Contralateral tremor (red nucleus)

• Ipsilateral CN III palsy (CN III fascicles• Contralateral hemitaxia (dentatothalamic

fibers in superior cerebellar peduncle)

• Ipsilateral lower motor neuron facial paralysis (CN III)

• Ipsilateral abducens paralysis (CN VI fibers)

• Contalateral hemiparesis (corticospinal tract in basis pontis)

• Ipsilateral lower motor neuron facial paralysis (nucleus or fascicles of CN VII)

• Ipsilateral gaze paralysis (nucleus abducens palsy)

• Contralateral hemiparesis (corticospinal tract in basis pontis) Rev. 06|15|2016

LOCALIZATION

Medial midbrain

Midbrain tegmentum

Midbrain tegmentum (dorsal)

Midbrain

Ventral pons

Dorsal pons regmentum

VASCULAR SUPPLY

PCA perforators

PCA perforators

PCA perforators

PCA perforators

Basilar artery perforators, median and paramedian

perforators

Basilar artery perforators

MIDBRAIN SYNDROMES

PONTINE SYNDROMES

Functional Neurology Seminars LP © 2016 Dr. Datis Kharrazian and Dr. Brandon Brock

BRAIN STEM CLINICAL SYNDROMES

NAME

Ventral pontine syndrome

Marie-Foix syndrome

Wallenberg syndrome

Dejerine’s syndrome (medial medullary syndrome)

AFFECTED TERRITORY

CLINICAL SYMPTOMS (anatomy)

• Ipsilateral CN VI palsy (CN VI fascicles• Contralateral hemiparesis (corticospinal

tract in basis pontis)

• Ipsilateral cerebellar ataxia (corticopontocerbellar fibers

• Contralateral hemiparesis (corticospinal tract in basis pontis)

• Variable contralateral decrease in pain and temperature sensation (spinothalamic tract involvement)

• Ipsilateral hemiataxia (inferior cerebellar peduncle)

• Dysphagia, hoarseness, ipsilateral palatal weakness (nucleus ambigous)

• Horner’s syndrome (sympatheti• Ipsilateral face, contralateral body

decrease in pain and temperature sensation (spinal tract and nucleus of V and lateral spinothalamic tract)

• Contralateral hemiparesis (medullary pyramid)

• Contralateral decrease in vibration/proprioception sensation in limbs (medial lemniscus)

• Ipsilateral CN XII palsy

Rev. 06|15|2016

LOCALIZATION

Ventral pons

Base of pons

Lateral medulla

Medial medulla

VASCULAR SUPPLY

Basilar artery, paramedian perforators

Basilar artery perforators

PICA

Vertebral artery perforators, anterior spinal artyer

MEDULLARY SYNDROMES

AICA, anterior inferior cerebellar artery; CN, cranial nerve; PCA, posterior cerebral artery; PICA, posterior inferior cerebellar artery.