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Symptoms and Signs

Syndrome

Contralateral hemiparesis (maximal in the leg), urinary incontinence, apathy, confusion, poor judgment, mutism, grasp reflex, gait apraxia

Anterior cerebral artery (uncommon)

Contralateral hemiparesis (worse in the arm and face than in the leg), dysarthria, hemianesthesia, contralateral homonymous hemianopia, aphasia (if the dominant hemisphere is affected) or apraxia and sensory neglect (if the nondominant hemisphere is affected)

Middle cerebral artery (common)

Contralateral homonymous hemianopia, unilateral cortical blindness, memory loss, unilateral 3rd cranial nerve palsy, hemiballismus

Posterior cerebral artery

Monocular loss of vision (amaurosis)

Ophthalmic artery (a branch of the internal carotid artery)

Unilateral or bilateral cranial nerve deficits (eg, nystagmus, vertigo, dysphagia, dysarthria, diplopia, blindness), truncal or limb ataxia, spastic paresis, crossed sensory and motor deficits*, impaired consciousness, coma, death (if basilar artery occlusion is complete), tachycardia, labile blood pressure

Vertebrobasilar system

Absence of cortical deficits plus one of the following:

  • Pure motor hemiparesis

  • Pure sensory hemianesthesia

  • Ataxic hemiparesis

  • Dysarthria–clumsy hand syndrome

Lacunar infarcts

* Ipsilateral facial sensory loss or motor weakness with contralateral body hemianesthesia or hemiparesis indicates a lesion at the pons or medulla.