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Cerebrovascular Syndromes

Last Updated: September 27, 2018

Table 1: Cerebral Ischemia Syndromes
Resulting symptoms and signs from occlusion of the artery listed in left column
Anterior Cerebral Artery
  • Contralateral sensory neuropathy (preferential lower limb)
  • Contralateral motor neuropathy (preferential lower limb)
  • Bilateral gaze deviation to side of infarction
  • Apraxia (left sided ideomotor)
  • Akinetic mutism
  • Primitive reflexes (grasp, suck)
  • Behavioral abnormalities (apathy)
  • Reduced spontaneous speech
  • Urinary incontinence
Middle Cerebral Artery
  • Contralateral sensory neuropathy (preferential face and upper limb)
  • Contralateral motor neuropathy (preferential face and upper limb)
  • Left hemispheric infarction:
  • Aphasia (motor, sensory, global)
  • Gerstmann syndrome
  • Right hemispheric infarction:
  • Left-sided hemineglect
  • Amusia
  • Prosopagnosia
  • Constructional apraxia
  • Apractognosia
  • Dressing apraxia
  • Atopognosia
  • Asomatognosia
  • Anosognosia
Anterior Choroidal Artery
  • Contralateral sensory neuropathy
  • Contralateral motor neuropathy
  • Homonymous hemianopia
Posterior Cerebral Artery
  • Contralateral homonymous hemianopia/quadrantanopia
  • Alexia without agraphia
  • Memory impairment
  • Choreoathetosis
  • Contralateral hemiballismus
  • Oculomotor palsy
  • INO
  • Vertical gaze palsy
  • Cortical blindness
  • Coma
Table 2: Midbrain Vascular Syndromes
List of midbrain vascular syndromes and corresponding dysfunctional structures
Weber’s Syndrome
  • Contralateral hemiplegia
  • Ipsilateral CN III palsy
Claude’s Syndrome
  • Contralateral hemiataxia, nucleus ruber tremor (Holmes’ tremor)
  • Cerbellar signs
  • Ipsilateral CN III palsy

Benedict’s Syndrome

  • Contralateral hemichorea/athetosis or intention tremor
  • Ipsilateral CN III palsy
Parinaud’s Syndrome
  • Vertical gaze palsy
  • Lid lag and Collier’s sign
  • Pupillary light dissociation
Table 3: Pontine Vascular Syndromes
List of pontine vascular syndromes and corresponding dysfunctional structures
Ataxic Hemiparesis
  • Ipsilateral hemiataxia
  • Hemiparesis (LE > UE)
  • Nystagmus
  • Paresthesia
  • Dysarthria
Locked-in Syndrome
  • Quadriplegia
  • Horizontal gaze palsy
  • Aphonia
Foville’s Syndrome
  • Ipsilateral CN VII palsy
  • Horizontal gaze palsy (ipsilateral to lesion)
  • Contralateral hemiplegia

Dysarthria-Clumsy Hand Syndrome

  • Ipsilateral CN VII palsy
  • Dysarthria
  • Ipsilateral UE hyperreflexia
  • Ipsilateral Babinski sign
  • Ipsilateral UE paresis / dyscoordination

Millard-Gubler Syndrome

  • Ipsilateral CN VII palsy
  • Ipsilateral CN VI palsy
  • Contralateral hemiplegia

Marie-Foix Syndrome

  • Contralateral hemiparesis
  • Contralateral hemihypesthesia
  • Ipsilateral cerebellar ataxia

Raymond-Cestan Syndrome

  • Contralateral sensory loss
  • Cerebellar ataxia
  • Contralateral hemiparesis
  • Conjugate gaze dysfunction
Table 4: Medullary Vascular Syndromes
List of medullary vascular syndromes and corresponding dysfunctional structures
Wallenberg’s Syndrome
  • Ipsilateral pharyngeal, palatal, and vocal cord paralysis
  • Ipsilateral Horner’s syndrome
  • Ipsilateral facial and contralateral body hypalgesia / thermoanesthesia
  • Ipsilateral cerebellar signs
  • Diplopia
Lateral Ponto-medullary Syndrome
  • Ipsilateral facial paresis
  • Ipsilateral tinnitus (rare abnormalities in hearing)
  • Ipsilateral pharyngeal, palatal, and vocal cord paralysis
  • Ipsilateral Horner’s syndrome
  • Ipsilateral facial and contralateral body hypalgesia/thermoanesthesia
  • Ipsilateral cerebellar signs
  • Diplopia

Dejerine Anterior Bulbar Syndrome

  • Contralateral proprioception and vibratory sensation loss
  • Ipsilateral hemiparesis and atrophy of bulbar muscles
  • Contralateral hemiplegia (not effecting face)
Table 5: Elevated Intracranial Pressure
Differential list for elevated intracranial pressure
Neoplastic
  • Primary (glioma, meningioma, oligodendroglioma, medulloblastoma, schwannoma)
  • Meningeal carcinomatosis
  • Metastasis
Vascular
  • Infarction (large)
  • Hematoma (parenchymal, SAH, epidural, subdural)
  • Aneurysm
  • Anemia (pernicious, iron deficiency)
  • Congestive heart failure
  • Venous sinus thrombosis
  • Hypertensive encephalopathy
Endocrine
  • Pregnancy state
  • Hypoparathyroidism
  • Addison’s disease
Infectious
  • Meningitis (bacterial, viral, fungal, parasitic)
  • Encephalitis (viral)
  • Abscess (bacterial, fungal)
  • Meningismus
Inflammatory
  • Multiple sclerosis
  • Sarcoidosis
  • Histiocytosis
  • Mastoiditis
  • Vasculitis
  • Reye’s syndrome
  • Cerebral edema
Toxic
  • Lead
  • Arsenic
  • Sulfonamide
  • Tetracycline
  • Penicillin
Metabolic
  • Hyper-/hypo-vitaminosis A
  • Diabetic ketoacidosis
Congenital
  • Hydrocephalus (also acquired)
Miscellaneous
  • Trauma
  • Pseudotumor cerebri
  • Paget’s disease
  • COPD
  • Post-status epilepticus
  • Wiscott-Aldrich syndrome
  • Obesity

DOI: https://doi.org/10.18791/nsatlas.v2.02.1.5

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