Stroke classification by Anatomy

Information for
health care professionals

click on brain to return to index page

Neuroland

Neuro Med

Neuro Note

Practice hint

Relax page

PubMed

DNS

Stroke Syndromes by anatomy

Cortical strokes

Middle cerebral artery

	contralateral hemiparesis and sensory loss, face and upper extremity more involved
	contralateral hemianopsia
	aphasia/aprosodia
	gaze abnormalities
	extinction on simultaneous touching, apraxia

Anterior cerebral artery

	contralateral hemiparesis and sensory loss, lower extremity more involved
	disconnection syndrome
	abulia, akinetic mutism

Posterior cerebral artery

	contralateral hemianopsia with macular sparing
	disconnection syndrome

Lacunar syndromes of cerebral hemisphere (no diplopia)

Ventral posterior thalamus

pure sensory loss without weakness

Post limb Internal Capsule

pure motor weakness without sensory loss, confusion or visual field defect
(may also be caused by cerebral peduncle infarct)

Genu of internal capsule

Dysarthria clumsy hand syndrome

Subthalamic nucleus

Contralateral Hemiballismus

Midbrain syndromes (Clue: III nerve palsy or vertical gaze problem)

Tegmentum, red nucleus, III n

Claude's syndrome: Ipsilateral III palsy & contralateral ataxia

above plus cerebral peduncle

Benedikt's syndrome: above plus contralateral weakness

III nerve + cerebral peduncle (red nucleus spared)

Weber's syndrome: ipsilateral III palsy + contralateral weakness

Dorsal midbrain

Perinaud's syndrome: paralysis of up gaze, convergence- retraction nystagmus, lid retraction

Above + paramedian midbrain

Nothnagel's syndrome: III palsy, vertical gaze paralysis, ipsilateral ataxia

Pontine syndromes ( VI nerve, horizontal gaze problem or VII nerve palsy)

middle cerebellar peduncle + corticospinal tract

Raymond-Cestan syndrome: ipsilateral ataxia + contralateral weakness

Paramedian pons

One-and-a-half syndrome: ipsilateral horizontal gaze palsy plus contralateral INO

Ventral pons

Millard-Gubler syndrome: VI & VII palsy, contralateral hemiparesis

Medulla syndromes (clue: facial sensory loss or Horner's syndrome, ipsilateral tongue, palate, scm paralysis.)

Dorsolateral medulla

Wallenberg's syndrome: ipsilateral ataxia, Horner's syndrome, facial sensory loss, contralateral loss of pain & temperature

Lateral medulla

Ipsilateral ataxia, horner's syndrome, facial sensory loss, ipsilateral paralysis of soft palate, vocal cords or sternocleidomastoid

Oxfordshire Stroke Subtype Classification:

	Uses clinical history and physical exam findings to classify stroke patients into 5 subtypes
	675 cases of first-ever stroke encountered over 5 years
	Interobserver reliability for classification employing the Oxfordshire system is good
	Subtypes are associated with different incidences of medical complications and dependency at discharge

	Primary intracerebral hemorrhage (PICH)
	Total anterior circulation infarct (TACI): 17%, high mortality and poor chance of good functional outcome
	Partial anterior circulation infarct (PACI): 24%, more likely to have an early recurrent stroke
	Lacunar infarct (LACI: )25%.
	Posterior circulation infarct (POCI): 24%, more likely to have a late recurrent stroke but an overall good functional outcome

Stroke information center

Return to index page