Stroke

• See also Acute stroke management
• See also Transient ischemic attack

Classification

• Intracerebral hemorrhage
• Subarachnoid hemorrhage
• Ischemia/infarct

Syndromes

Lacunar Syndromes

• Pure motor: contralateral posterior limb of internal capsule or corona radiata
• Pure sensory: contralateral ventroposterolateral thalamic nucleus
• Mixed sensorimotor: contralateral thalamus and posterior limb of internal capsule
• Dysarthria-clumsy hand: contralateral base of pons
• Ataxic hemiparesis: contralateral posterior limb of internal capsule or base of pons
• Hemiballismus/hemichorea: contralateral subthalamic nucleus

Posterior Circulation Strokes

Carotid Artery Dissection

• Usually associated with neck pain

Lateral Medullary Syndrome

• Contralateral pain/temperature sensory deficit with ipsilateral Horner's syndrome, cranial nerve deficits
• Often presents with dizziness, nausea/vomiting, nystagmus, dysphagia/dysarthria/dysphonia, Horner syndrome
• Pain or an unpleasant feeling in the face is sometimes a prominent early feature
• Most commonly caused by vertebral artery or PICA occlusion

Further Reading

• Boulanger et al. Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018. Internat J Stroke 2018.