Guess the Lesion
Contralateral face and arm weakness with expressive aphasia points to this artery being occluded.
Left MCA (Broca Area)
Contralateral leg weakness greater than arm or face suggests this artery.
ACA → supplies medial surface of motor cortex (leg area).
Contralateral homonymous hemianopia with macular sparing results from infarct of this artery.
PCA
Pure motor hemiparesis is most often due to a lacunar infarct in this structure.
Posterior Limb internal capsule
This is the most common cause of ischemic stroke.
Atherosclerotic plaque rupture with thromboembolism — most often from carotid or MCA territory.
Contralateral face and arm weakness plus sensory loss and left homonymous hemianopia occur in this vascular lesion.
Right MCA
A patient demonstrates abulia (loss of willpower), urinary incontinence, and leg weakness. Which artery is likely occluded?
ACA (cingulate gyrus)
A patient cannot recognize faces but can see objects normally. This results from damage to this structure in PCA territory.
Fusiform gyrus ( inferior temporal lobe )
Pure sensory stroke is due to lacunar infarct of this structure.
Ventral posterolateral (VPL) and ventral posteromedial (VPM) thalamic nuclei → supplied by thalamogeniculate branches of PCA.
Cytotoxic edema in ischemic stroke results primarily from failure of this ion pump.
NA+/K+ ATPase
A patient with right gaze preference, left hemineglect, and anosognosia likely has this lesion.
Right MCA (non dominant hemisphere)
Disconnection between the hemispheres after a stroke involving the corpus callosum is due to occlusion of this artery.
ACA (pericallosar branch)
A right PCA infarct causing left homonymous hemianopia and hemisensory loss implies involvement of this subcortical structure.
Dysarthria–clumsy hand syndrome arises from lesion where?
Basis Pontis
Sudden rupture of small penetrating arteries due to chronic hypertension causes this type of stroke.
Lacunar infarct
Global aphasia (both expressive and receptive) suggests occlusion of which specific branch of MCA?
Proximal MCA trunk (before division)
A patient can’t move his left leg but also shows emotional indifference and flat affect. Lesion?
Right ACA
Visual hallucinations or peduncular hallucinosis occur from infarction in this PCA-related structure.
Midbrain (tectum/peduncle)
Ataxic hemiparesis comes from a lacune here.
Contralateral internal capsule or pons
Name the three main zones of ischemic stroke, from most to least viable.
Core infarct → ischemic penumbra → oligemic zone.
MCA stroke sparing the face but causing arm weakness indicates involvement of this specific subregion.
Superior Division of MCA
After a TIA, the most critical next step in evaluation is to assess for this source.
Carotid stenosis/ A-fib
tPA must be administered within this time window from symptom onset (most guidelines).
Within 4.5 hours
Hypertensive lipohyalinosis of lenticulostriate arteries most often damages which cortical region?
Basal Ganglia
Transient ischemic attack (TIA) differs from stroke based on this defining criterion.
No infarction on imaging and symptoms <24 hr (usually <1 hr).