Ischemic stroke physical examination: Difference between revisions

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A [[systematic review]] found that acute facial paresis, arm drift, or abnormal speech are the best findings.<ref name="pmid15900010">{{cite journal |author=Goldstein L, Simel D |title=Is this patient having a stroke? |journal=JAMA |volume=293 |issue=19 |pages=2391-402 |year=2005 |id=PMID 15900010 | doi=10.1001/jama.296.16.2012  url=http://jama.ama-assn.org/cgi/content/full/296/16/2012}}</ref>
A [[systematic review]] found that acute facial paresis, arm drift, or abnormal speech are the best findings.<ref name="pmid15900010">{{cite journal |author=Goldstein L, Simel D |title=Is this patient having a stroke? |journal=JAMA |volume=293 |issue=19 |pages=2391-402 |year=2005 |id=PMID 15900010 | doi=10.1001/jama.296.16.2012  url=http://jama.ama-assn.org/cgi/content/full/296/16/2012}}</ref>
==Physical Examination==
==Physical Examination==
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! style="background: #4479BA; padding: 5px 5px;" rowspan=2 | {{fontcolor|#FFFFFF|Site of Infarction}}
|+
! style="background: #4479BA; padding: 5px 5px;" rowspan=2 | {{fontcolor|#FFFFFF|Specific area involved}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Vessel involved}}
! style="background: #4479BA; padding: 5px 5px;" colspan=8 | {{fontcolor|#FFFFFF|Physical exam findings}}
! colspan="1" style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Site of infarction}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Physical examination}}
|-
|-
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Motor strength}}
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | '''Anterior cerebral artery '''<ref name="pmid17895117">{{cite journal| author=Nagaratnam N, Davies D, Chen E| title=Clinical effects of anterior cerebral artery infarction. | journal=J Stroke Cerebrovasc Dis | year= 1998 | volume= 7 | issue= 6 | pages= 391-7 | pmid=17895117 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17895117  }} </ref><ref name="pmid12453077">{{cite journal| author=Kumral E, Bayulkem G, Evyapan D, Yunten N| title=Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings. | journal=Eur J Neurol | year= 2002 | volume= 9 | issue= 6 | pages= 615-24 | pmid=12453077 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12453077  }} </ref>
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Reflexes}}
| style="padding: 5px 5px; background: #F5F5F5;" |
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Cranial nerves involved}}
'''Superficial branch'''
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Sensations}}
*[[Prefrontal cortex]]
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Coordination}}
*[[Primary motor cortex]]
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Babinski's sign}}
*[[Primary sensory cortex]]
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Pupils}}
*Supplemental [[motor cortex]]
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Pupillary reflex}}
| style="padding: 5px 5px; background: #F5F5F5;" |
'''Right ACA'''<ref name="pmid17895117">{{cite journal| author=Nagaratnam N, Davies D, Chen E| title=Clinical effects of anterior cerebral artery infarction. | journal=J Stroke Cerebrovasc Dis | year= 1998 | volume= 7 | issue= 6 | pages= 391-7 | pmid=17895117 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17895117  }} </ref><ref name="pmid12453077">{{cite journal| author=Kumral E, Bayulkem G, Evyapan D, Yunten N| title=Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings. | journal=Eur J Neurol | year= 2002 | volume= 9 | issue= 6 | pages= 615-24 | pmid=12453077 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12453077  }} </ref>
*Left sided motor weakness- contralateral lower limb
*Left sided sensory loss-contralateral lower limb
*[[Hemineglect]] <ref name="pmid12453077">{{cite journal| author=Kumral E, Bayulkem G, Evyapan D, Yunten N| title=Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings. | journal=Eur J Neurol | year= 2002 | volume= 9 | issue= 6 | pages= 615-24 | pmid=12453077 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12453077  }} </ref>
*Behavioral abnormalities
*[[Urinary incontinence]]
'''Left ACA'''<ref name="pmid17895117">{{cite journal| author=Nagaratnam N, Davies D, Chen E| title=Clinical effects of anterior cerebral artery infarction. | journal=J Stroke Cerebrovasc Dis | year= 1998 | volume= 7 | issue= 6 | pages= 391-7 | pmid=17895117 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17895117  }} </ref><ref name="pmid7356415">{{cite journal| author=Alexander MP, Schmitt MA| title=The aphasia syndrome of stroke in the left anterior cerebral artery territory. | journal=Arch Neurol | year= 1980 | volume= 37 | issue= 2 | pages= 97-100 | pmid=7356415 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7356415  }} </ref>
*Right sided motor weakness- contralateral lower limb
*Right sided sensory loss-contralateral lower limb
*Transcortical motor [[aphasia]](non fluent)<ref name="pmid12453077">{{cite journal| author=Kumral E, Bayulkem G, Evyapan D, Yunten N| title=Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings. | journal=Eur J Neurol | year= 2002 | volume= 9 | issue= 6 | pages= 615-24 | pmid=12453077 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12453077  }} </ref><ref name="pmid7356415">{{cite journal| author=Alexander MP, Schmitt MA| title=The aphasia syndrome of stroke in the left anterior cerebral artery territory. | journal=Arch Neurol | year= 1980 | volume= 37 | issue= 2 | pages= 97-100 | pmid=7356415 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7356415  }} </ref>
*Mutism
*Contralateral grasp and sucking reflex (physical exam finding)
*Disorganized thinking
*[[Urinary incontinence]]
*Behavioral abnormalities
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''Cerebral cortex''
| style="padding: 5px 5px; background: #F5F5F5;" |
'''Deep branches''' (medial lenticulostriate, Heubner's artery)<ref name="pmid17940169">{{cite journal| author=den Heijer T, Ruitenberg A, Bakker J, Hertzberger L, Kerkhoff H| title=Neurological picture. Bilateral caudate nucleus infarction associated with variant in circle of Willis. | journal=J Neurol Neurosurg Psychiatry | year= 2007 | volume= 78 | issue= 11 | pages= 1175 | pmid=17940169 | doi=10.1136/jnnp.2006.112656 | pmc=2117617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17940169  }} </ref><ref name="pmid2927642">{{cite journal| author=Mendez MF, Adams NL, Lewandowski KS| title=Neurobehavioral changes associated with caudate lesions. | journal=Neurology | year= 1989 | volume= 39 | issue= 3 | pages= 349-54 | pmid=2927642 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2927642  }} </ref>
:*Anterior part of [[thalamus]]
:*[[Anterior limb of internal capsule]] (inferior half)
:*Head of [[caudate nucleus]]
:*[[Putamen]]
:*Rostrum of [[corpus callosum]]
:*[[Septum pellucidum]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Abulia]] <ref name="pmid17940169">{{cite journal| author=den Heijer T, Ruitenberg A, Bakker J, Hertzberger L, Kerkhoff H| title=Neurological picture. Bilateral caudate nucleus infarction associated with variant in circle of Willis. | journal=J Neurol Neurosurg Psychiatry | year= 2007 | volume= 78 | issue= 11 | pages= 1175 | pmid=17940169 | doi=10.1136/jnnp.2006.112656 | pmc=2117617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17940169  }} </ref><ref name="pmid2927642">{{cite journal| author=Mendez MF, Adams NL, Lewandowski KS| title=Neurobehavioral changes associated with caudate lesions. | journal=Neurology | year= 1989 | volume= 39 | issue= 3 | pages= 349-54 | pmid=2927642 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2927642  }} </ref><ref name="pmid16510225">{{cite journal| author=Mizuta H, Motomura N| title=Memory dysfunction in caudate infarction caused by Heubner's recurring artery occlusion. | journal=Brain Cogn | year= 2006 | volume= 61 | issue= 2 | pages= 133-8 | pmid=16510225 | doi=10.1016/j.bandc.2005.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16510225  }} </ref>
*[[Aphasia]]
*[[Dysarhtria|Dysarthria]]
*Memory impairment<ref name="pmid16510225">{{cite journal| author=Mizuta H, Motomura N| title=Memory dysfunction in caudate infarction caused by Heubner's recurring artery occlusion. | journal=Brain Cogn | year= 2006 | volume= 61 | issue= 2 | pages= 133-8 | pmid=16510225 | doi=10.1016/j.bandc.2005.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16510225  }} </ref>
*[[Confusion]]
*[[Confabulation]]<ref name="pmid17940169">{{cite journal| author=den Heijer T, Ruitenberg A, Bakker J, Hertzberger L, Kerkhoff H| title=Neurological picture. Bilateral caudate nucleus infarction associated with variant in circle of Willis. | journal=J Neurol Neurosurg Psychiatry | year= 2007 | volume= 78 | issue= 11 | pages= 1175 | pmid=17940169 | doi=10.1136/jnnp.2006.112656 | pmc=2117617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17940169  }} </ref>
|-
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" |'''Middle cerebral artery'''<ref name="pmid23139684">{{cite journal| author=Lemieux F, Lanthier S, Chevrier MC, Gioia L, Rouleau I, Cereda C et al.| title=Insular ischemic stroke: clinical presentation and outcome. | journal=Cerebrovasc Dis Extra | year= 2012 | volume= 2 | issue= 1 | pages= 80-7 | pmid=23139684 | doi=10.1159/000343177 | pmc=3492997 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23139684  }} </ref>
*Most common site of infarction
| style="padding: 5px 5px; background: #F5F5F5;" |
*'''Right superficial division (RSD)'''
:*Motor cortex (left head,neck and arm)
:*Sensory cortex (left head, trunk and arm)
| style="padding: 5px 5px; background: #F5F5F5;" |
*Contralateral left arm and face weakness
*[[Hemineglect|Contralateral Hemineglect]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
*'''Left superficial division (LSD)'''
:*[[Broca's area]] (expressive speech area)<ref name="pmid25016386">{{cite journal| author=Fridriksson J, Fillmore P, Guo D, Rorden C| title=Chronic Broca's Aphasia Is Caused by Damage to Broca's and Wernicke's Areas. | journal=Cereb Cortex | year= 2015 | volume= 25 | issue= 12 | pages= 4689-96 | pmid=25016386 | doi=10.1093/cercor/bhu152 | pmc=4669036 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25016386  }} </ref><ref name="pmid4062622">{{cite journal| author=Henderson VW| title=Lesion localization in Broca's aphasia. Implications from Broca's aphasia without hemiparesis. | journal=Arch Neurol | year= 1985 | volume= 42 | issue= 12 | pages= 1210-2 | pmid=4062622 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4062622  }} </ref>
:*[[Wernicke's area]] (receptive speech area)
:*[[Motor cortex]] (right head, neck and arm)
:*[[Sensory cortex]] (right head, neck and arm)
| style="padding: 5px 5px; background: #F5F5F5;" |
*Contralateral right arm and facial weakness
*Non fluent [[aphasia]] ([[Broca's aphasia]])<ref name="pmid25016386">{{cite journal| author=Fridriksson J, Fillmore P, Guo D, Rorden C| title=Chronic Broca's Aphasia Is Caused by Damage to Broca's and Wernicke's Areas. | journal=Cereb Cortex | year= 2015 | volume= 25 | issue= 12 | pages= 4689-96 | pmid=25016386 | doi=10.1093/cercor/bhu152 | pmc=4669036 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25016386  }} </ref><ref name="pmid4062622">{{cite journal| author=Henderson VW| title=Lesion localization in Broca's aphasia. Implications from Broca's aphasia without hemiparesis. | journal=Arch Neurol | year= 1985 | volume= 42 | issue= 12 | pages= 1210-2 | pmid=4062622 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4062622  }} </ref><ref name="pmid9577663">{{cite journal| author=Soma Y| title=[Cerebrovascular disorder and the language areas]. | journal=Rinsho Shinkeigaku | year= 1997 | volume= 37 | issue= 12 | pages= 1117-9 | pmid=9577663 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9577663  }} </ref>
*Fluent [[aphasia]] ([[Wernicke's]] aphasia)<ref name="pmid9577663">{{cite journal| author=Soma Y| title=[Cerebrovascular disorder and the language areas]. | journal=Rinsho Shinkeigaku | year= 1997 | volume= 37 | issue= 12 | pages= 1117-9 | pmid=9577663 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9577663  }} </ref>
*Contralateral [[homonymous hemianopsia]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Lenticulostriate artery|'''Lenticulostriate''']] '''branches'''<ref name="pmid11843697">{{cite journal| author=Bang OY, Heo JH, Kim JY, Park JH, Huh K| title=Middle cerebral artery stenosis is a major clinical determinant in striatocapsular small, deep infarction. | journal=Arch Neurol | year= 2002 | volume= 59 | issue= 2 | pages= 259-63 | pmid=11843697 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11843697  }} </ref><ref name="pmid1709298">{{cite journal| author=Ghika J, Bogousslavsky J, Regli F| title=Infarcts in the territory of lenticulostriate branches from the middle cerebral artery. Etiological factors and clinical features in 65 cases. | journal=Schweiz Arch Neurol Psychiatr (1985) | year= 1991 | volume= 142 | issue= 1 | pages= 5-18 | pmid=1709298 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1709298  }} </ref>
:*Striatum ([[Caudate nucleus|caudate]] and [[putamen]])
:*[[Globus pallidus]]
:*[[Internal capsule]] (anterior, posterior limb and genu)
| style="padding: 5px 5px; background: #F5F5F5;" |
'''Classical [[lacunar syndromes]]'''<ref name="pmid19210194">{{cite journal| author=Arboix A, Martí-Vilalta JL| title=Lacunar stroke. | journal=Expert Rev Neurother | year= 2009 | volume= 9 | issue= 2 | pages= 179-96 | pmid=19210194 | doi=10.1586/14737175.9.2.179 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19210194  }} </ref><ref name="pmid1565233">{{cite journal| author=Melo TP, Bogousslavsky J, van Melle G, Regli F| title=Pure motor stroke: a reappraisal. | journal=Neurology | year= 1992 | volume= 42 | issue= 4 | pages= 789-95 | pmid=1565233 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1565233  }} </ref><ref name="pmid8256570">{{cite journal| author=Tei H, Uchiyama S, Maruyama S| title=Capsular infarcts: location, size and etiology of pure motor hemiparesis, sensorimotor stroke and ataxic hemiparesis. | journal=Acta Neurol Scand | year= 1993 | volume= 88 | issue= 4 | pages= 264-8 | pmid=8256570 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8256570  }} </ref>
*Pure motor stroke
*Pure sensory stroke
*Ataxic hemiparesis
*Mixed sensorimotor stroke
*Dysarthria clumsy hand syndrome
|-
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | '''[[Posterior cerebral artery]]<ref name="pmid10773642">{{cite journal| author=Brandt T, Steinke W, Thie A, Pessin MS, Caplan LR| title=Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature. | journal=Cerebrovasc Dis | year= 2000 | volume= 10 | issue= 3 | pages= 170-82 | pmid=10773642 | doi=16053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10773642  }} </ref><ref name="pmid22377879">{{cite journal| author=Cereda C, Carrera E| title=Posterior cerebral artery territory infarctions. | journal=Front Neurol Neurosci | year= 2012 | volume= 30 | issue=  | pages= 128-31 | pmid=22377879 | doi=10.1159/000333610 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22377879  }} </ref><ref name="pmid10404984">{{cite journal| author=Yamamoto Y, Georgiadis AL, Chang HM, Caplan LR| title=Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry. | journal=Arch Neurol | year= 1999 | volume= 56 | issue= 7 | pages= 824-32 | pmid=10404984 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10404984  }} </ref>'''
| style="padding: 5px 5px; background: #F5F5F5;" |
'''Cortical branches<ref name="pmid10773642">{{cite journal| author=Brandt T, Steinke W, Thie A, Pessin MS, Caplan LR| title=Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature. | journal=Cerebrovasc Dis | year= 2000 | volume= 10 | issue= 3 | pages= 170-82 | pmid=10773642 | doi=16053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10773642  }} </ref>''''
:*Occipital cortex<ref name="pmid3606035">{{cite journal| author=Pessin MS, Lathi ES, Cohen MB, Kwan ES, Hedges TR, Caplan LR| title=Clinical features and mechanism of occipital infarction. | journal=Ann Neurol | year= 1987 | volume= 21 | issue= 3 | pages= 290-9 | pmid=3606035 | doi=10.1002/ana.410210311 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3606035  }} </ref>
:*Splenium of [[corpus callosum]]
:*[[Hippocampus]]
| style="padding: 5px 5px; background: #F5F5F5;" |'''Right PCA<ref name="pmid3742339">{{cite journal| author=Fisher CM| title=The posterior cerebral artery syndrome. | journal=Can J Neurol Sci | year= 1986 | volume= 13 | issue= 3 | pages= 232-9 | pmid=3742339 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3742339  }} </ref>'''


| style="padding: 5px 5px; background: #F5F5F5;" | Frontal lobe
*Unilateral headaches
Perietal lobe
*Contralateral left [[homonymous hemianopsia]]<ref name="pmid10773642">{{cite journal| author=Brandt T, Steinke W, Thie A, Pessin MS, Caplan LR| title=Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature. | journal=Cerebrovasc Dis | year= 2000 | volume= 10 | issue= 3 | pages= 170-82 | pmid=10773642 | doi=16053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10773642  }} </ref><ref name="pmid3606035">{{cite journal| author=Pessin MS, Lathi ES, Cohen MB, Kwan ES, Hedges TR, Caplan LR| title=Clinical features and mechanism of occipital infarction. | journal=Ann Neurol | year= 1987 | volume= 21 | issue= 3 | pages= 290-9 | pmid=3606035 | doi=10.1002/ana.410210311 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3606035  }} </ref>
temporal lobe
*[[Cortical blindness]]
Occipital lobe
*[[Visual agnosia]]
! style="padding: 5px 5px; background: #F5F5F5;" | ++
*Complex hallucinations
! style="padding: 5px 5px; background: #F5F5F5;" | +
*[[Prosopagnosia]]<ref name="pmid7199655">{{cite journal| author=Damasio AR, Damasio H, Van Hoesen GW| title=Prosopagnosia: anatomic basis and behavioral mechanisms. | journal=Neurology | year= 1982 | volume= 32 | issue= 4 | pages= 331-41 | pmid=7199655 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7199655  }} </ref>
! style="padding: 5px 5px; background: #F5F5F5;" | ++
*[[Anomic aphasia]]
! style="padding: 5px 5px; background: #F5F5F5;" | +
'''Left PCA<ref name="pmid3742339">{{cite journal| author=Fisher CM| title=The posterior cerebral artery syndrome. | journal=Can J Neurol Sci | year= 1986 | volume= 13 | issue= 3 | pages= 232-9 | pmid=3742339 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3742339  }} </ref><ref name="pmid10404984">{{cite journal| author=Yamamoto Y, Georgiadis AL, Chang HM, Caplan LR| title=Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry. | journal=Arch Neurol | year= 1999 | volume= 56 | issue= 7 | pages= 824-32 | pmid=10404984 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10404984  }} </ref><ref name="pmid4434176">{{cite journal| author=Caplan LR, Hedley-Whyte T| title=Cuing and memory dysfunction in alexia without agraphia. A case report. | journal=Brain | year= 1974 | volume= 97 | issue= 2 | pages= 251-62 | pmid=4434176 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4434176  }} </ref>'''
! style="padding: 5px 5px; background: #F5F5F5;" | +
*[[Alexia]] without [[agraphia]]<ref name="pmid4434176">{{cite journal| author=Caplan LR, Hedley-Whyte T| title=Cuing and memory dysfunction in alexia without agraphia. A case report. | journal=Brain | year= 1974 | volume= 97 | issue= 2 | pages= 251-62 | pmid=4434176 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4434176  }} </ref><ref name="pmid5945970">{{cite journal| author=Geschwind N, Fusillo M| title=Color-naming defects in association with alexia. | journal=Arch Neurol | year= 1966 | volume= 15 | issue= 2 | pages= 137-46 | pmid=5945970 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5945970  }} </ref><ref name="pmid5945970">{{cite journal| author=Geschwind N, Fusillo M| title=Color-naming defects in association with alexia. | journal=Arch Neurol | year= 1966 | volume= 15 | issue= 2 | pages= 137-46 | pmid=5945970 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5945970  }} </ref>
! style="padding: 5px 5px; background: #F5F5F5;" | ++
*[[Homonymous hemianopsia|Contralateral right homonymous hemianopsia]]<ref name="pmid3606035">{{cite journal| author=Pessin MS, Lathi ES, Cohen MB, Kwan ES, Hedges TR, Caplan LR| title=Clinical features and mechanism of occipital infarction. | journal=Ann Neurol | year= 1987 | volume= 21 | issue= 3 | pages= 290-9 | pmid=3606035 | doi=10.1002/ana.410210311 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3606035  }} </ref>
! style="padding: 5px 5px; background: #F5F5F5;" | +
*[[Gerstmann syndrome]]<ref name="pmid4434176">{{cite journal| author=Caplan LR, Hedley-Whyte T| title=Cuing and memory dysfunction in alexia without agraphia. A case report. | journal=Brain | year= 1974 | volume= 97 | issue= 2 | pages= 251-62 | pmid=4434176 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4434176  }} </ref>
! style="padding: 5px 5px; background: #F5F5F5;" | +
*[[Cortical blindness]]
*[[Visual agnosia]]
*Memory deficit
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
'''Ganglionic branches<ref name="pmid22377879">{{cite journal| author=Cereda C, Carrera E| title=Posterior cerebral artery territory infarctions. | journal=Front Neurol Neurosci | year= 2012 | volume= 30 | issue=  | pages= 128-31 | pmid=22377879 | doi=10.1159/000333610 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22377879  }} </ref>'''
:*[[Thalamus]] <ref name="pmid22377879">{{cite journal| author=Cereda C, Carrera E| title=Posterior cerebral artery territory infarctions. | journal=Front Neurol Neurosci | year= 2012 | volume= 30 | issue=  | pages= 128-31 | pmid=22377879 | doi=10.1159/000333610 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22377879  }} </ref>
:*[[Subthalamus]]
:*[[Midbrain]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Hemisensory loss<ref name="pmid1640235">{{cite journal| author=Melo TP, Bogousslavsky J| title=Hemiataxia-hypesthesia: a thalamic stroke syndrome. | journal=J Neurol Neurosurg Psychiatry | year= 1992 | volume= 55 | issue= 7 | pages= 581-4 | pmid=1640235 | doi= | pmc=489170 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1640235  }} </ref>
*[[Hemiparesis|Contralateral hemiparesis]]<ref name="pmid1640235">{{cite journal| author=Melo TP, Bogousslavsky J| title=Hemiataxia-hypesthesia: a thalamic stroke syndrome. | journal=J Neurol Neurosurg Psychiatry | year= 1992 | volume= 55 | issue= 7 | pages= 581-4 | pmid=1640235 | doi= | pmc=489170 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1640235  }} </ref>
*Thalamic pain syndrome <ref name="pmid22377879">{{cite journal| author=Cereda C, Carrera E| title=Posterior cerebral artery territory infarctions. | journal=Front Neurol Neurosci | year= 2012 | volume= 30 | issue=  | pages= 128-31 | pmid=22377879 | doi=10.1159/000333610 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22377879  }} </ref>
*[[Hemiballismus]]
*[[Oculomotor nerve palsy|Occulomotor nerve palsy]]
*Intention [[Tremor|tremors]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''Brain stem''
| rowspan="6" style="padding: 5px 5px; background: #DCDCDC;" | '''Vertebrobasilar artery<ref name="pmid10926972">{{cite journal| author=Caplan L| title=Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. | journal=Stroke | year= 2000 | volume= 31 | issue= 8 | pages= 2011-23 | pmid=10926972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10926972  }} </ref>'''
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |
*Midbrain
*[[Midbrain]]
*Pons
| style="padding: 5px 5px; background: #F5F5F5;" |
*Medulla
*[[Weber syndrome]]<ref name="pmid24778625">{{cite journal| author=Nouh A, Remke J, Ruland S| title=Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management. | journal=Front Neurol | year= 2014 | volume= 5 | issue=  | pages= 30 | pmid=24778625 | doi=10.3389/fneur.2014.00030 | pmc=3985033 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24778625  }}</ref>
! style="padding: 5px 5px; background: #F5F5F5;" | ++
|-
! style="padding: 5px 5px; background: #F5F5F5;" | ++
| style="padding: 5px 5px; background: #F5F5F5;" |
! style="padding: 5px 5px; background: #F5F5F5;" | ++
*[[Medulla]]
! style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" |
! style="padding: 5px 5px; background: #F5F5F5;" | +
*[[Lateral medullary syndrome]]<ref name="pmid10926972">{{cite journal| author=Caplan L| title=Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. | journal=Stroke | year= 2000 | volume= 31 | issue= 8 | pages= 2011-23 | pmid=10926972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10926972  }} </ref><ref name="pmid8503798">{{cite journal| author=Sacco RL, Freddo L, Bello JA, Odel JG, Onesti ST, Mohr JP| title=Wallenberg's lateral medullary syndrome. Clinical-magnetic resonance imaging correlations. | journal=Arch Neurol | year= 1993 | volume= 50 | issue= 6 | pages= 609-14 | pmid=8503798 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8503798  }} </ref><ref name="pmid22346215">{{cite journal| author=Shetty SR, Anusha R, Thomas PS, Babu SG| title=Wallenberg's syndrome. | journal=J Neurosci Rural Pract | year= 2012 | volume= 3 | issue= 1 | pages= 100-2 | pmid=22346215 | doi=10.4103/0976-3147.91980 | pmc=3271596 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22346215  }} </ref>
! style="padding: 5px 5px; background: #F5F5F5;" | ++
*[[Medial medullary syndrome]]<ref name="pmid10926972">{{cite journal| author=Caplan L| title=Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. | journal=Stroke | year= 2000 | volume= 31 | issue= 8 | pages= 2011-23 | pmid=10926972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10926972  }} </ref><ref name="pmid7660396">{{cite journal| author=Kim JS, Kim HG, Chung CS| title=Medial medullary syndrome. Report of 18 new patients and a review of the literature. | journal=Stroke | year= 1995 | volume= 26 | issue= 9 | pages= 1548-52 | pmid=7660396 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7660396  }} </ref><ref name="pmid22787495">{{cite journal| author=Kim K, Lee HS, Jung YH, Kim YD, Nam HS, Nam CM et al.| title=Mechanism of medullary infarction based on arterial territory involvement. | journal=J Clin Neurol | year= 2012 | volume= 8 | issue= 2 | pages= 116-22 | pmid=22787495 | doi=10.3988/jcn.2012.8.2.116 | pmc=3391616 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22787495  }} </ref>
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
! style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Pons]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Locked-in syndrome ]]<ref name="pmid3738962">{{cite journal| author=Patterson JR, Grabois M| title=Locked-in syndrome: a review of 139 cases. | journal=Stroke | year= 1986 | volume= 17 | issue= 4 | pages= 758-64 | pmid=3738962 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3738962  }} </ref><ref name="pmid4810896">{{cite journal| author=Karp JS, Hurtig HI| title="Locked-in" state with bilateral midbrain infarcts. | journal=Arch Neurol | year= 1974 | volume= 30 | issue= 2 | pages= 176-8 | pmid=4810896 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4810896  }} </ref>
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Cerebellum]]<ref name="pmid10926972">{{cite journal| author=Caplan L| title=Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. | journal=Stroke | year= 2000 | volume= 31 | issue= 8 | pages= 2011-23 | pmid=10926972 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10926972  }} </ref><ref name="pmid2535662">{{cite journal| author=Amarenco P, Hauw JJ| title=[Anatomy of the cerebellar arteries]. | journal=Rev Neurol (Paris) | year= 1989 | volume= 145 | issue= 4 | pages= 267-76 | pmid=2535662 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2535662  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Difficulty maintaining balance
*[[Vertigo]]
*Nausea
*Vomiting
*Tremors
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''Cerebellum''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" | Community-acquired, ingestion of undercooked poultry
*Thalamus
! style="padding: 5px 5px; background: #F5F5F5;" | ++
| style="padding: 5px 5px; background: #F5F5F5;" |
! style="padding: 5px 5px; background: #F5F5F5;" | +
* Central pain syndrome
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | "Central pathway involved"
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Spinothalamic tract
*Occipital cortex
*Corticospinal tract
| style="padding: 5px 5px; background: #F5F5F5;" |
*Medial leminscus
* Visual deficit
! style="padding: 5px 5px; background: #F5F5F5;" | ±
|-
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
|}
|}
===Glasgow coma score===
===Glasgow coma score===
[[Glasgow coma score]] helps determine the severity of [[infarction]], extent of damage and prognosis in unconscious or semi conscious patients. The score is determined by adding score in each category with the maximum score of 15 and minimum score of 3.<ref name="pmid10863122">{{cite journal| author=Sternbach GL| title=The Glasgow coma scale. | journal=J Emerg Med | year= 2000 | volume= 19 | issue= 1 | pages= 67-71 | pmid=10863122 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10863122  }} </ref><ref name="pmid:    26564211">{{cite journal| author=Reith FC, Van den Brande R, Synnot A, Gruen R, Maas AI| title=The reliability of the Glasgow Coma Scale: a systematic review. | journal=Intensive Care Med | year= 2016 | volume= 42 | issue= 1 | pages= 3-15 | pmid=:    26564211 | doi=10.1007/s00134-015-4124-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26564211  }} </ref><ref name="pmid14631703">{{cite journal| author=Gabbe BJ, Cameron PA, Finch CF| title=The status of the Glasgow Coma Scale. | journal=Emerg Med (Fremantle) | year= 2003 | volume= 15 | issue= 4 | pages= 353-60 | pmid=14631703 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14631703  }} </ref><ref name="pmid16009770">{{cite journal| author=Tsao JW, Hemphill JC, Johnston SC, Smith WS, Bonovich DC| title=Initial Glasgow Coma Scale score predicts outcome following thrombolysis for posterior circulation stroke. | journal=Arch Neurol | year= 2005 | volume= 62 | issue= 7 | pages= 1126-9 | pmid=16009770 | doi=10.1001/archneur.62.7.1126 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16009770 }} </ref><ref name="pmid2509651">{{cite journal| author=Haug RH, Picard U, Matejczyk MB, Indresano AT| title=The infected prosthetic total temporomandibular joint replacement: report of two cases. | journal=J Oral Maxillofac Surg | year= 1989 | volume= 47 | issue= 11 | pages= 1210-4 | pmid=2509651 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2509651 }} </ref><ref name="pmid8403953">{{cite journal| author=Bastos PG, Sun X, Wagner DP, Wu AW, Knaus WA| title=Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: findings from the Acute Physiology and Chronic Health Evaluation III study. | journal=Crit Care Med | year= 1993 | volume= 21 | issue= 10 | pages= 1459-65 | pmid=8403953 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8403953  }} </ref>
[[Glasgow coma score]] helps determine the severity of [[infarction]], extent of damage and prognosis in unconscious or semi conscious patients. The score is determined by adding score in each category with the maximum score of 15 and minimum score of 3.<ref name="pmid10863122">{{cite journal| author=Sternbach GL| title=The Glasgow coma scale. | journal=J Emerg Med | year= 2000 | volume= 19 | issue= 1 | pages= 67-71 | pmid=10863122 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10863122  }} </ref><ref name="pmid:    26564211">{{cite journal| author=Reith FC, Van den Brande R, Synnot A, Gruen R, Maas AI| title=The reliability of the Glasgow Coma Scale: a systematic review. | journal=Intensive Care Med | year= 2016 | volume= 42 | issue= 1 | pages= 3-15 | pmid=:    26564211 | doi=10.1007/s00134-015-4124-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26564211  }} </ref><ref name="pmid14631703">{{cite journal| author=Gabbe BJ, Cameron PA, Finch CF| title=The status of the Glasgow Coma Scale. | journal=Emerg Med (Fremantle) | year= 2003 | volume= 15 | issue= 4 | pages= 353-60 | pmid=14631703 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14631703  }} </ref><ref name="pmid16009770">{{cite journal| author=Tsao JW, Hemphill JC, Johnston SC, Smith WS, Bonovich DC| title=Initial Glasgow Coma Scale score predicts outcome following thrombolysis for posterior circulation stroke. | journal=Arch Neurol | year= 2005 | volume= 62 | issue= 7 | pages= 1126-9 | pmid=16009770 | doi=10.1001/archneur.62.7.1126 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16009770  }} </ref><ref name="pmid8403953">{{cite journal| author=Bastos PG, Sun X, Wagner DP, Wu AW, Knaus WA| title=Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: findings from the Acute Physiology and Chronic Health Evaluation III study. | journal=Crit Care Med | year= 1993 | volume= 21 | issue= 10 | pages= 1459-65 | pmid=8403953 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8403953  }} </ref>
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Revision as of 16:23, 14 November 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

A systematic review found that acute facial paresis, arm drift, or abnormal speech are the best findings.[1]

Physical Examination

Vessel involved Site of infarction Physical examination
Anterior cerebral artery [2][3]

Superficial branch

Right ACA[2][3]

Left ACA[2][4]

  • Right sided motor weakness- contralateral lower limb
  • Right sided sensory loss-contralateral lower limb
  • Transcortical motor aphasia(non fluent)[3][4]
  • Mutism
  • Contralateral grasp and sucking reflex (physical exam finding)
  • Disorganized thinking
  • Urinary incontinence
  • Behavioral abnormalities

Deep branches (medial lenticulostriate, Heubner's artery)[5][6]

Middle cerebral artery[8]
  • Most common site of infarction
  • Right superficial division (RSD)
  • Motor cortex (left head,neck and arm)
  • Sensory cortex (left head, trunk and arm)
  • Left superficial division (LSD)

Classical lacunar syndromes[14][15][16]

  • Pure motor stroke
  • Pure sensory stroke
  • Ataxic hemiparesis
  • Mixed sensorimotor stroke
  • Dysarthria clumsy hand syndrome
Posterior cerebral artery[17][18][19]

Cortical branches[17]'

Right PCA[21]

Left PCA[21][19][23]

Ganglionic branches[18]

Vertebrobasilar artery[26]
  • Difficulty maintaining balance
  • Vertigo
  • Nausea
  • Vomiting
  • Tremors
  • Thalamus
  • Central pain syndrome
  • Occipital cortex
  • Visual deficit

Glasgow coma score

Glasgow coma score helps determine the severity of infarction, extent of damage and prognosis in unconscious or semi conscious patients. The score is determined by adding score in each category with the maximum score of 15 and minimum score of 3.[35][36][37][38][39]

Parameter Patient response Glassgow coma score
Eye opening
  • Spontaneous
  • To speech
  • To pain
  • No response
  • 4
  • 3
  • 2
  • 1
Verbal response
  • Oriented to time, place and person
  • Confused
  • Inappropriate words
  • Incomprehensible words
  • No response
  • 5
  • 4
  • 3
  • 2
  • 1
Motor response
  • Obeys commands
  • Moves to localized pain
  • Flexion withdrawl from pain
  • Abnormal flexion to pain (decorticate posture)
  • Abnormal extension to pain (decerebrate posture)
  • No response
  • 6
  • 5
  • 4
  • 3
  • 2
  • 1

Interpretation of Glasgow coma scale:

The following interpretation of glasgow coma scale may help determine the prognostic outcome in patients with brain injury:

Mild brain injury

Glasgow coma scale of 13-15

Moderate brain injury

Glasgow coma scale of 9-12

Severe brain injury

Glasgow coma scale of 3-8

For more information about glasgow coma scoring system, click here.

Ear

  • Altered hearing may be present.

Extremities

Neurologic

  • Abnormal speech
  • Acute facial paresis
  • Decreased reflexes: gag, swallow, pupil reactivity to light
  • Disorganized thinking, confusion, hypersexual gestures (with involvement of frontal lobe)
  • Hemineglect (involvement of parietal lobe)
  • Loss of co-ordination
  • Memory deficits (involvement of temporal lobe)
  • Numbness
  • Reduction in sensory or vibratory sensation

References

  1. ↑ 1.0 1.1 Goldstein L, Simel D (2005). "Is this patient having a stroke?". JAMA. 293 (19): 2391–402. doi:10.1001/jama.296.16.2012 url=http://jama.ama-assn.org/cgi/content/full/296/16/2012 Check |doi= value (help). PMID 15900010.
  2. ↑ 2.0 2.1 2.2 Nagaratnam N, Davies D, Chen E (1998). "Clinical effects of anterior cerebral artery infarction". J Stroke Cerebrovasc Dis. 7 (6): 391–7. PMID 17895117.
  3. ↑ 3.0 3.1 3.2 3.3 Kumral E, Bayulkem G, Evyapan D, Yunten N (2002). "Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings". Eur J Neurol. 9 (6): 615–24. PMID 12453077.
  4. ↑ 4.0 4.1 Alexander MP, Schmitt MA (1980). "The aphasia syndrome of stroke in the left anterior cerebral artery territory". Arch Neurol. 37 (2): 97–100. PMID 7356415.
  5. ↑ 5.0 5.1 5.2 den Heijer T, Ruitenberg A, Bakker J, Hertzberger L, Kerkhoff H (2007). "Neurological picture. Bilateral caudate nucleus infarction associated with variant in circle of Willis". J Neurol Neurosurg Psychiatry. 78 (11): 1175. doi:10.1136/jnnp.2006.112656. PMC 2117617. PMID 17940169.
  6. ↑ 6.0 6.1 Mendez MF, Adams NL, Lewandowski KS (1989). "Neurobehavioral changes associated with caudate lesions". Neurology. 39 (3): 349–54. PMID 2927642.
  7. ↑ 7.0 7.1 Mizuta H, Motomura N (2006). "Memory dysfunction in caudate infarction caused by Heubner's recurring artery occlusion". Brain Cogn. 61 (2): 133–8. doi:10.1016/j.bandc.2005.11.002. PMID 16510225.
  8. ↑ Lemieux F, Lanthier S, Chevrier MC, Gioia L, Rouleau I, Cereda C; et al. (2012). "Insular ischemic stroke: clinical presentation and outcome". Cerebrovasc Dis Extra. 2 (1): 80–7. doi:10.1159/000343177. PMC 3492997. PMID 23139684.
  9. ↑ 9.0 9.1 Fridriksson J, Fillmore P, Guo D, Rorden C (2015). "Chronic Broca's Aphasia Is Caused by Damage to Broca's and Wernicke's Areas". Cereb Cortex. 25 (12): 4689–96. doi:10.1093/cercor/bhu152. PMC 4669036. PMID 25016386.
  10. ↑ 10.0 10.1 Henderson VW (1985). "Lesion localization in Broca's aphasia. Implications from Broca's aphasia without hemiparesis". Arch Neurol. 42 (12): 1210–2. PMID 4062622.
  11. ↑ 11.0 11.1 Soma Y (1997). "[Cerebrovascular disorder and the language areas]". Rinsho Shinkeigaku. 37 (12): 1117–9. PMID 9577663.
  12. ↑ Bang OY, Heo JH, Kim JY, Park JH, Huh K (2002). "Middle cerebral artery stenosis is a major clinical determinant in striatocapsular small, deep infarction". Arch Neurol. 59 (2): 259–63. PMID 11843697.
  13. ↑ Ghika J, Bogousslavsky J, Regli F (1991). "Infarcts in the territory of lenticulostriate branches from the middle cerebral artery. Etiological factors and clinical features in 65 cases". Schweiz Arch Neurol Psychiatr (1985). 142 (1): 5–18. PMID 1709298.
  14. ↑ Arboix A, Martí-Vilalta JL (2009). "Lacunar stroke". Expert Rev Neurother. 9 (2): 179–96. doi:10.1586/14737175.9.2.179. PMID 19210194.
  15. ↑ Melo TP, Bogousslavsky J, van Melle G, Regli F (1992). "Pure motor stroke: a reappraisal". Neurology. 42 (4): 789–95. PMID 1565233.
  16. ↑ Tei H, Uchiyama S, Maruyama S (1993). "Capsular infarcts: location, size and etiology of pure motor hemiparesis, sensorimotor stroke and ataxic hemiparesis". Acta Neurol Scand. 88 (4): 264–8. PMID 8256570.
  17. ↑ 17.0 17.1 17.2 Brandt T, Steinke W, Thie A, Pessin MS, Caplan LR (2000). "Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature". Cerebrovasc Dis. 10 (3): 170–82. doi:16053 Check |doi= value (help). PMID 10773642.
  18. ↑ 18.0 18.1 18.2 18.3 Cereda C, Carrera E (2012). "Posterior cerebral artery territory infarctions". Front Neurol Neurosci. 30: 128–31. doi:10.1159/000333610. PMID 22377879.
  19. ↑ 19.0 19.1 Yamamoto Y, Georgiadis AL, Chang HM, Caplan LR (1999). "Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry". Arch Neurol. 56 (7): 824–32. PMID 10404984.
  20. ↑ 20.0 20.1 20.2 Pessin MS, Lathi ES, Cohen MB, Kwan ES, Hedges TR, Caplan LR (1987). "Clinical features and mechanism of occipital infarction". Ann Neurol. 21 (3): 290–9. doi:10.1002/ana.410210311. PMID 3606035.
  21. ↑ 21.0 21.1 Fisher CM (1986). "The posterior cerebral artery syndrome". Can J Neurol Sci. 13 (3): 232–9. PMID 3742339.
  22. ↑ Damasio AR, Damasio H, Van Hoesen GW (1982). "Prosopagnosia: anatomic basis and behavioral mechanisms". Neurology. 32 (4): 331–41. PMID 7199655.
  23. ↑ 23.0 23.1 23.2 Caplan LR, Hedley-Whyte T (1974). "Cuing and memory dysfunction in alexia without agraphia. A case report". Brain. 97 (2): 251–62. PMID 4434176.
  24. ↑ 24.0 24.1 Geschwind N, Fusillo M (1966). "Color-naming defects in association with alexia". Arch Neurol. 15 (2): 137–46. PMID 5945970.
  25. ↑ 25.0 25.1 Melo TP, Bogousslavsky J (1992). "Hemiataxia-hypesthesia: a thalamic stroke syndrome". J Neurol Neurosurg Psychiatry. 55 (7): 581–4. PMC 489170. PMID 1640235.
  26. ↑ 26.0 26.1 26.2 26.3 Caplan L (2000). "Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000". Stroke. 31 (8): 2011–23. PMID 10926972.
  27. ↑ Nouh A, Remke J, Ruland S (2014). "Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management". Front Neurol. 5: 30. doi:10.3389/fneur.2014.00030. PMC 3985033. PMID 24778625.
  28. ↑ Sacco RL, Freddo L, Bello JA, Odel JG, Onesti ST, Mohr JP (1993). "Wallenberg's lateral medullary syndrome. Clinical-magnetic resonance imaging correlations". Arch Neurol. 50 (6): 609–14. PMID 8503798.
  29. ↑ Shetty SR, Anusha R, Thomas PS, Babu SG (2012). "Wallenberg's syndrome". J Neurosci Rural Pract. 3 (1): 100–2. doi:10.4103/0976-3147.91980. PMC 3271596. PMID 22346215.
  30. ↑ Kim JS, Kim HG, Chung CS (1995). "Medial medullary syndrome. Report of 18 new patients and a review of the literature". Stroke. 26 (9): 1548–52. PMID 7660396.
  31. ↑ Kim K, Lee HS, Jung YH, Kim YD, Nam HS, Nam CM; et al. (2012). "Mechanism of medullary infarction based on arterial territory involvement". J Clin Neurol. 8 (2): 116–22. doi:10.3988/jcn.2012.8.2.116. PMC 3391616. PMID 22787495.
  32. ↑ Patterson JR, Grabois M (1986). "Locked-in syndrome: a review of 139 cases". Stroke. 17 (4): 758–64. PMID 3738962.
  33. ↑ Karp JS, Hurtig HI (1974). ""Locked-in" state with bilateral midbrain infarcts". Arch Neurol. 30 (2): 176–8. PMID 4810896.
  34. ↑ Amarenco P, Hauw JJ (1989). "[Anatomy of the cerebellar arteries]". Rev Neurol (Paris). 145 (4): 267–76. PMID 2535662.
  35. ↑ Sternbach GL (2000). "The Glasgow coma scale". J Emerg Med. 19 (1): 67–71. PMID 10863122.
  36. ↑ Reith FC, Van den Brande R, Synnot A, Gruen R, Maas AI (2016). "The reliability of the Glasgow Coma Scale: a systematic review". Intensive Care Med. 42 (1): 3–15. doi:10.1007/s00134-015-4124-3. PMID 26564211 : 26564211 Check |pmid= value (help).
  37. ↑ Gabbe BJ, Cameron PA, Finch CF (2003). "The status of the Glasgow Coma Scale". Emerg Med (Fremantle). 15 (4): 353–60. PMID 14631703.
  38. ↑ Tsao JW, Hemphill JC, Johnston SC, Smith WS, Bonovich DC (2005). "Initial Glasgow Coma Scale score predicts outcome following thrombolysis for posterior circulation stroke". Arch Neurol. 62 (7): 1126–9. doi:10.1001/archneur.62.7.1126. PMID 16009770.
  39. ↑ Bastos PG, Sun X, Wagner DP, Wu AW, Knaus WA (1993). "Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: findings from the Acute Physiology and Chronic Health Evaluation III study". Crit Care Med. 21 (10): 1459–65. PMID 8403953.

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