Make me understand stroke and their artery damage feature key points no explanations
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Stroke - Artery Damage Key Points
🔴 Middle Cerebral Artery (MCA)
Territory: Lateral hemisphere, internal capsule, basal ganglia
| Segment | Key Features |
|---|---|
| M1 stem | Contralateral hemiplegia (face + arm + leg), hemianesthesia, gaze deviation toward lesion, global aphasia (dominant) |
| Superior division | Face + arm > leg weakness, Broca's aphasia (dominant), contralateral neglect (non-dominant) |
| Inferior division | Wernicke's aphasia (dominant), hemianopia, constructional apraxia (non-dominant) |
| Deep (lenticulostriate) | Pure motor hemiplegia, putamen/internal capsule infarct, no cortical signs |
| Malignant MCA | Massive edema, midline shift, herniation |
🟠 Anterior Cerebral Artery (ACA)
Territory: Medial frontal/parietal lobe, anterior corpus callosum
| Feature | Detail |
|---|---|
| Motor | Leg > arm weakness (contralateral) |
| Sensory | Leg > arm sensory loss |
| Behavioral | Abulia, akinetic mutism, disinhibition |
| Urinary | Incontinence |
| Alien hand | With anterior callosal involvement |
| Bilateral | Paraplegia + akinetic mutism if both ACAs from one trunk |
🟡 Posterior Cerebral Artery (PCA)
Territory: Occipital lobe, thalamus, midbrain, posterior temporal lobe
| Feature | Detail |
|---|---|
| Visual | Contralateral homonymous hemianopia (macular sparing possible) |
| Cortical blindness | Bilateral PCA; Anton syndrome (denial of blindness) |
| Thalamic | Contralateral hemisensory loss, thalamic pain (Dejerine-Roussy) |
| Memory | Amnesia (medial temporal/hippocampal) |
| Midbrain | CN III palsy + contralateral hemiplegia (Weber syndrome) |
| Balint syndrome | Bilateral parieto-occipital - simultagnosia, optic ataxia, ocular apraxia |
🟢 Anterior Choroidal Artery
Territory: Posterior limb internal capsule, optic tract, lateral geniculate
| Feature | Detail |
|---|---|
| Classic triad | Contralateral hemiplegia + hemianesthesia + hemianopia |
| Note | Deficits may be incomplete; tract involvement variable |
🔵 Vertebral Artery (PICA territory)
Territory: Lateral medulla, posterior inferior cerebellum
Wallenberg Syndrome (Lateral Medullary Syndrome)
| Feature | Detail |
|---|---|
| Ipsilateral face | Pain/temp loss (CN V nucleus) |
| Contralateral body | Pain/temp loss (spinothalamic) |
| Dysphagia/dysarthria | CN IX, X involvement |
| Horner syndrome | Ipsilateral (descending sympathetics) |
| Vertigo, nausea, hiccups | Vestibular nuclei |
| Cerebellar signs | Ipsilateral limb ataxia |
| NO hemiplegia | Pyramidal tract spared |
🟣 Basilar Artery
Territory: Pons, midbrain, cerebellum, bilateral PCA
| Syndrome | Features |
|---|---|
| Top of basilar | Bilateral PCA + thalamus; visual loss, behavioral change, somnolence |
| Locked-in | Bilateral ventral pontine infarct; quadriplegia + anarthria, preserved vertical gaze + consciousness |
| Paramedian pontine | Ipsilateral CN VI + VII, contralateral hemiplegia (Foville/Millard-Gubler) |
| AICA territory | Ipsilateral facial palsy, deafness, vertigo, Horner, contralateral body pain/temp loss |
| PICA territory | Wallenberg (see above) |
| Complete occlusion | Coma, quadriplegia, death |
🔑 Quick Memory Rule
| Artery | Remember As |
|---|---|
| MCA | Face + arm, aphasia / neglect |
| ACA | Leg, abulia |
| PCA | Vision, thalamic pain, amnesia |
| Ant. Choroidal | Triple: hemi-motor + sensory + visual |
| Vertebral/PICA | Wallenberg = crossed face/body, no paralysis |
| Basilar | Locked-in, top-of-basilar syndrome |
Source: Adams and Victor's Principles of Neurology, 12th Edition, Chapter 33
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