Stroke and Cerebrovascular Syndromes
Vascular Anatomy and Stroke Logic
Territories matter
Stroke syndromes often follow arterial territories. Recognizing the pattern helps predict deficits, guide imaging, and determine whether a large vessel is involved.
Common vascular territories
| Territory | Typical deficits |
|---|---|
| MCA | Face and arm weakness, aphasia or neglect, visual field loss |
| ACA | Leg weakness, abulia, frontal signs |
| PCA | Visual field deficits, memory or visual processing problems |
| Brainstem perforators | Cranial nerve deficits with long-tract signs |
Time is brain
Acute stroke evaluation is driven by rapid recognition, urgent brain imaging, and fast treatment decisions.
Sudden right face and arm weakness with aphasia most strongly suggests infarction in the left:
Dominant MCA stroke commonly causes contralateral face and arm weakness plus aphasia.
Correct answer: Middle cerebral artery
What is the key initial imaging study for suspected acute stroke in most emergency settings?
Noncontrast CT is used quickly to exclude hemorrhage and guide acute treatment decisions.
Correct answer: noncontrast head CT
Ischemic Stroke Mechanisms
Major ischemic mechanisms
Thrombotic/atherosclerotic
- Large-artery disease
- May have preceding transient ischemic attacks
Embolic
- Sudden onset with maximal deficit at onset
- Often from atrial fibrillation or cardiac source
Which mechanism is most associated with an abrupt maximal deficit at onset and a cardiac source?
Embolic strokes often present suddenly with maximal symptoms immediately.
Correct answer: Embolic stroke
Name one common risk factor for lacunar infarction.
Chronic hypertension is a major risk factor for small-vessel disease.
Correct answer: hypertension
Hemorrhage and Secondary Prevention
When bleeding matters
Intracerebral hemorrhage and subarachnoid hemorrhage require different diagnostic and management priorities than ischemic stroke. Blood pressure control, reversal of coagulopathy, and neurosurgical evaluation may be critical.
Severe thunderclap headache with meningeal signs raises concern for:
Thunderclap headache is classic for subarachnoid hemorrhage.
Correct answer: Subarachnoid hemorrhage
Why is atrial fibrillation important in stroke prevention?
Atrial fibrillation can form atrial thrombi that embolize to the brain.
Correct answer: it increases embolic stroke risk