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©2013 UpToDate ® Print Email Acute stroke syndromes according to vascular territory and mechanism Artery involved Syndrome Pathophysiology Anterior cerebral artery Motor and/or sensory deficit (leg >> face, arm) Grasp, sucking reflexes Abulia, paratonic rigidity, gait apraxia Embolic > atherothrombotic Middle cerebral artery Dominant hemisphere: aphasia, motor and sensory deficit (face, arm > leg > foot), may be complete hemiplegia if internal capsule involved, homonymous hemianopia Non-dominant hemisphere: neglect, anosognosia, motor and sensory deficit (face, arm > leg > foot), homonymous hemianopia Embolic > atherothrombotic Posterior cerebral artery Homonymous hemianopia; alexia without agraphia (dominant hemisphere); visual hallucinations, visual perseverations (calcarine cortex); sensory loss, choreoathetosis, spontaneous pain (thalamus); III nerve palsy, paresis of vertical eye movement, motor deficit (cerebral peduncle, midbrain) Embolic > atherothrombotic Penetrating vessels Pure motor hemiparesis (classic lacunar syndromes) Pure sensory deficit Pure sensory-motor deficit Hemiparesis, homolateral ataxia Dysarthria/clumsy hand Small artery (lacunar) infarct Vertebrobasilar Cranial nerve palsies Crossed sensory deficits Diplopia, dizziness, nausea, vomiting, dysarthria, dysphagia, hiccup Limb and gait ataxia Motory deficit Coma Bilateral signs suggest basilar artery disease Embolic = atherothrombotic Internal carotid artery Progressive or stuttering onset of MCA syndrome, occasionally ACA syndrome as well if insufficient collateral flow Atherothrombotic > embolic