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Stroke Syndromes by anatomy
Cortical strokes
Middle cerebral artery
bulletcontralateral hemiparesis and sensory loss, face and upper extremity more involved
bulletcontralateral hemianopsia
bulletaphasia/aprosodia
bulletgaze abnormalities
bulletextinction on simultaneous touching, apraxia
Anterior cerebral artery
bulletcontralateral hemiparesis and sensory loss, lower extremity more involved
bulletdisconnection syndrome
bulletabulia, akinetic mutism
Posterior cerebral artery
bulletcontralateral hemianopsia with macular sparing
bulletdisconnection 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:
bulletUses clinical history and physical exam findings to classify stroke patients into 5 subtypes
bullet675 cases of first-ever stroke encountered over 5 years
bulletInterobserver reliability for classification employing the Oxfordshire system is good
bulletSubtypes are associated with different incidences of medical complications and dependency at discharge
bulletPrimary intracerebral hemorrhage (PICH)
bulletTotal anterior circulation infarct (TACI): 17%, high mortality and poor chance of good functional outcome
bulletPartial anterior circulation infarct (PACI):  24%, more likely to have an early recurrent stroke
bulletLacunar infarct (LACI: )25%.
bulletPosterior circulation infarct (POCI): 24%, more likely to have a late recurrent stroke but an overall good functional outcome

Stroke information center

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