Ischemic stroke history and symptoms

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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

History and Symptoms

Detailed history may suggest the underlying cause for ischemic stroke. The symptoms of an ischemic stroke vary widely depending on the site and blood supply of the area involved:


Vessel involved	Site of infarction	History and symptoms
Anterior cerebral artery ^[1]^[2] Rare	Superficial branch Prefrontal cortex Primary motor cortex Primary sensory cortex Supplemental motor cortex	Right ACA^[1]^[2] Left sided motor weakness- contralateral lower limb Left sided sensory loss-contralateral lower limb Hemineglect ^[2] Behavioral abnormalities Urinary incontinence Left ACA^[1]^[3] Right sided motor weakness- contralateral lower limb Right sided sensory loss-contralateral lower limb Transcortical motor aphasia(non fluent)^[2]^[3] Mutism Contralateral grasp and sucking reflex (physical exam finding) Disorganized thinking Urinary incontinence Behavioral abnormalities
Anterior cerebral artery ^[1]^[2] Rare	Deep branches (medial lenticulostriate, Heubner's artery)^[4]^[5] Anterior part of thalamus Anterior limb of internal capsule (inferior half) Head of caudate nucleus Putamen Rostrum of corpus callosum Septum pellucidum	Abulia ^[4]^[5]^[6] Aphasia Dysarthria Memory impairment^[6] Confusion Confabulation^[4]
Middle cerebral artery^[7] Most common site of infarction	Right superficial division (RSD) Motor cortex (left head,neck and arm) Sensory cortex (left head, trunk and arm)	Contralateral left arm and face weakness Contralateral Hemineglect
	Left superficial division (LSD) Broca's area (expressive speech area)^[8]^[9] Wernicke's area (receptive speech area) Motor cortex (right head, neck and arm) Sensory cortex (right head, neck and arm)	Contralateral right arm and facial weakness Non fluent aphasia (Broca's aphasia)^[8]^[9]^[10] Fluent aphasia (Wernicke's aphasia)^[10] Contralateral homonymous hemianopsia
	Lenticulostriate branches^[11]^[12] Striatum (caudate and putamen) Globus pallidus Internal capsule (anterior, posterior limb and genu)	Classical lacunar syndromes^[13]^[14]^[15] Pure motor stroke Pure sensory stroke Ataxic hemiparesis Mixed sensorimotor stroke Dysarthria clumsy hand syndrome
Posterior cerebral artery^[16]^[17]^[18]	Cortical branches^[16]' Occipital cortex^[19] Splenium of corpus callosum Hippocampus	Right PCA^[20] Unilateral headaches Contralateral left homonymous hemianopsia^[16]^[19] Cortical blindness Visual agnosia Complex hallucinations Prosopagnosia^[21] Anomic aphasia Left PCA^[20]^[18]^[22] Alexia without agraphia^[22]^[23]^[23] Contralateral right homonymous hemianopsia^[19] Gerstmann syndrome^[22] Cortical blindness Visual agnosia Memory deficit
Posterior cerebral artery^[16]^[17]^[18]	Ganglionic branches^[17] Thalamus ^[17] Subthalamus Midbrain	Hemisensory loss^[24] Contralateral hemiparesis^[24] Thalamic pain syndrome ^[17] Hemiballismus Occulomotor nerve palsy Intention tremors
Vertebrobasilar artery^[25]	Midbrain	Weber syndrome
	Medulla	Lateral medullary syndrome^[25]^[26]^[27] Medial medullary syndrome^[25]^[28]^[29]
	Pons	Locked-in syndrome ^[30]^[31]
	Cerebellum^[25]^[32]	Difficulty maintaining balance Vertigo Nausea Vomiting Tremors
	Thalamus
	Occipital cortex

Blood supply of brain

The different vascular territories of the brain may be demonstrated in the images below:

References

↑ ^1.0 ^1.1 ^1.2 Nagaratnam N, Davies D, Chen E (1998). "Clinical effects of anterior cerebral artery infarction". J Stroke Cerebrovasc Dis. 7 (6): 391–7. PMID 17895117.
↑ ^2.0 ^2.1 ^2.2 ^2.3 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.
↑ ^3.0 ^3.1 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.
↑ ^4.0 ^4.1 ^4.2 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.
↑ ^5.0 ^5.1 Mendez MF, Adams NL, Lewandowski KS (1989). "Neurobehavioral changes associated with caudate lesions". Neurology. 39 (3): 349–54. PMID 2927642.
↑ ^6.0 ^6.1 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.
↑ 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.
↑ ^8.0 ^8.1 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.
↑ ^9.0 ^9.1 Henderson VW (1985). "Lesion localization in Broca's aphasia. Implications from Broca's aphasia without hemiparesis". Arch Neurol. 42 (12): 1210–2. PMID 4062622.
↑ ^10.0 ^10.1 Soma Y (1997). "[Cerebrovascular disorder and the language areas]". Rinsho Shinkeigaku. 37 (12): 1117–9. PMID 9577663.
↑ 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.
↑ 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.
↑ Arboix A, Martí-Vilalta JL (2009). "Lacunar stroke". Expert Rev Neurother. 9 (2): 179–96. doi:10.1586/14737175.9.2.179. PMID 19210194.
↑ Melo TP, Bogousslavsky J, van Melle G, Regli F (1992). "Pure motor stroke: a reappraisal". Neurology. 42 (4): 789–95. PMID 1565233.
↑ 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.
↑ ^16.0 ^16.1 ^16.2 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.
↑ ^17.0 ^17.1 ^17.2 ^17.3 Cereda C, Carrera E (2012). "Posterior cerebral artery territory infarctions". Front Neurol Neurosci. 30: 128–31. doi:10.1159/000333610. PMID 22377879.
↑ ^18.0 ^18.1 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.
↑ ^19.0 ^19.1 ^19.2 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.
↑ ^20.0 ^20.1 Fisher CM (1986). "The posterior cerebral artery syndrome". Can J Neurol Sci. 13 (3): 232–9. PMID 3742339.
↑ Damasio AR, Damasio H, Van Hoesen GW (1982). "Prosopagnosia: anatomic basis and behavioral mechanisms". Neurology. 32 (4): 331–41. PMID 7199655.
↑ ^22.0 ^22.1 ^22.2 Caplan LR, Hedley-Whyte T (1974). "Cuing and memory dysfunction in alexia without agraphia. A case report". Brain. 97 (2): 251–62. PMID 4434176.
↑ ^23.0 ^23.1 Geschwind N, Fusillo M (1966). "Color-naming defects in association with alexia". Arch Neurol. 15 (2): 137–46. PMID 5945970.
↑ ^24.0 ^24.1 Melo TP, Bogousslavsky J (1992). "Hemiataxia-hypesthesia: a thalamic stroke syndrome". J Neurol Neurosurg Psychiatry. 55 (7): 581–4. PMC 489170. PMID 1640235.
↑ ^25.0 ^25.1 ^25.2 ^25.3 Caplan L (2000). "Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000". Stroke. 31 (8): 2011–23. PMID 10926972.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Patterson JR, Grabois M (1986). "Locked-in syndrome: a review of 139 cases". Stroke. 17 (4): 758–64. PMID 3738962.
↑ Karp JS, Hurtig HI (1974). ""Locked-in" state with bilateral midbrain infarcts". Arch Neurol. 30 (2): 176–8. PMID 4810896.
↑ Amarenco P, Hauw JJ (1989). "[Anatomy of the cerebellar arteries]". Rev Neurol (Paris). 145 (4): 267–76. PMID 2535662.

Template:WS Template:WH

[pmid17895117-1] 1.0 ^1.1 ^1.2 Nagaratnam N, Davies D, Chen E (1998). "Clinical effects of anterior cerebral artery infarction". J Stroke Cerebrovasc Dis. 7 (6): 391–7. PMID 17895117.

[pmid12453077-2] 2.0 ^2.1 ^2.2 ^2.3 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.

[pmid7356415-3] 3.0 ^3.1 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.

[pmid17940169-4] 4.0 ^4.1 ^4.2 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.

[pmid2927642-5] 5.0 ^5.1 Mendez MF, Adams NL, Lewandowski KS (1989). "Neurobehavioral changes associated with caudate lesions". Neurology. 39 (3): 349–54. PMID 2927642.

[pmid16510225-6] 6.0 ^6.1 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.

[pmid23139684-7] 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.

[pmid25016386-8] 8.0 ^8.1 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.

[pmid4062622-9] 9.0 ^9.1 Henderson VW (1985). "Lesion localization in Broca's aphasia. Implications from Broca's aphasia without hemiparesis". Arch Neurol. 42 (12): 1210–2. PMID 4062622.

[pmid9577663-10] 10.0 ^10.1 Soma Y (1997). "[Cerebrovascular disorder and the language areas]". Rinsho Shinkeigaku. 37 (12): 1117–9. PMID 9577663.

[pmid11843697-11] 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.

[pmid1709298-12] 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.

[pmid19210194-13] Arboix A, Martí-Vilalta JL (2009). "Lacunar stroke". Expert Rev Neurother. 9 (2): 179–96. doi:10.1586/14737175.9.2.179. PMID 19210194.

[pmid1565233-14] Melo TP, Bogousslavsky J, van Melle G, Regli F (1992). "Pure motor stroke: a reappraisal". Neurology. 42 (4): 789–95. PMID 1565233.

[pmid8256570-15] 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.

[pmid10773642-16] 16.0 ^16.1 ^16.2 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.

[pmid22377879-17] 17.0 ^17.1 ^17.2 ^17.3 Cereda C, Carrera E (2012). "Posterior cerebral artery territory infarctions". Front Neurol Neurosci. 30: 128–31. doi:10.1159/000333610. PMID 22377879.

[pmid10404984-18] 18.0 ^18.1 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.

[pmid3606035-19] 19.0 ^19.1 ^19.2 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.

[pmid3742339-20] 20.0 ^20.1 Fisher CM (1986). "The posterior cerebral artery syndrome". Can J Neurol Sci. 13 (3): 232–9. PMID 3742339.

[pmid7199655-21] Damasio AR, Damasio H, Van Hoesen GW (1982). "Prosopagnosia: anatomic basis and behavioral mechanisms". Neurology. 32 (4): 331–41. PMID 7199655.

[pmid4434176-22] 22.0 ^22.1 ^22.2 Caplan LR, Hedley-Whyte T (1974). "Cuing and memory dysfunction in alexia without agraphia. A case report". Brain. 97 (2): 251–62. PMID 4434176.

[pmid5945970-23] 23.0 ^23.1 Geschwind N, Fusillo M (1966). "Color-naming defects in association with alexia". Arch Neurol. 15 (2): 137–46. PMID 5945970.

[pmid1640235-24] 24.0 ^24.1 Melo TP, Bogousslavsky J (1992). "Hemiataxia-hypesthesia: a thalamic stroke syndrome". J Neurol Neurosurg Psychiatry. 55 (7): 581–4. PMC 489170. PMID 1640235.

[pmid10926972-25] 25.0 ^25.1 ^25.2 ^25.3 Caplan L (2000). "Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000". Stroke. 31 (8): 2011–23. PMID 10926972.

[pmid8503798-26] 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.

[pmid22346215-27] 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.

[pmid7660396-28] 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.

[pmid22787495-29] 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.

[pmid3738962-30] Patterson JR, Grabois M (1986). "Locked-in syndrome: a review of 139 cases". Stroke. 17 (4): 758–64. PMID 3738962.

[pmid4810896-31] Karp JS, Hurtig HI (1974). ""Locked-in" state with bilateral midbrain infarcts". Arch Neurol. 30 (2): 176–8. PMID 4810896.

[pmid2535662-32] Amarenco P, Hauw JJ (1989). "[Anatomy of the cerebellar arteries]". Rev Neurol (Paris). 145 (4): 267–76. PMID 2535662.

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Ischemic stroke history and symptoms

Overview

History and Symptoms

Blood supply of brain

References

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