Stroke syndromes and their anatomic localization

Catalina Ionita MD (Dr. Ionita, Director of Neurocritical Care Services at the Catholic Health System of Buffalo, New York, has no relevant financial relationships to disclose.)
Steven R Levine MD, editor. (Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.)
Originally released May 10, 2004; last updated October 23, 2012; expires October 23, 2015

Overview

The first description of stroke syndromes originates in the 19th century. The most common clinical manifestation of stroke syndromes is motor weakness. Weakness distribution and associated signs and symptoms define a particular stroke syndrome and localization. Certain stroke syndromes point directly to specific pathogeneses that are unique to the anatomy and hemodynamics. Stroke subtypes and anatomical distribution differ among different racial groups. Prognosis and complications depend on the stroke syndrome, whereas the stroke subtype dictates the primary and secondary prevention strategy. However, early improvement of a stroke syndrome with poor prognosis can result in a reasonable outcome. In acute settings, attempted recanalization applies for all stroke syndromes with all pathogeneses. In this article, the authors discuss the various stroke syndromes, emphasize the possible occurrence of alien hand syndrome in association with anterior cerebral artery infarcts, and review the efficacy of 3 new oral anticoagulants in stroke and systemic embolic events prevention in comparison to warfarin.

Key points

 

• Since the nineteenth century, when first described, a myriad of stroke syndromes with proteiform clinical manifestations have been recognized

 

• Different outcomes in relation to stroke localization and pathogenesis have been established.

 

• Multiple rapid and efficient diagnostic techniques are currently available.

 

• Besides prevention and rehabilitation, treatment of stroke and its complications is standard of care.

 

• Evolving therapy remains an open chapter.

Historical note and terminology

The concept that individual brain regions are responsible for specific functions originated in the 19th century with the description of the first stroke syndromes. The earliest classical syndromes to be described were the brainstem syndromes of Weber (1863), Millard (1855), Gubler (1856), Foville (1858), Benedikt (1889), and Raymond-Cestan (1895) (Schmidt 2000). Charcot and his intern Bouchard described the apoplectic stroke syndromes and were the first to make a distinction between infarction and intracerebral hematoma (Goetz 2002). Charles Foix described the syndromes of infarction in middle cerebral artery, posterior cerebral artery, anterior cerebral artery, and vertebrobasilar territories. During the 20th century, Fisher substantially contributed by describing the findings in patients with internal carotid artery occlusion and lacunar infarcts (Fisher 2001). More recently, the technological revolution of CT, MRI, and diffusion-weighted imaging has allowed many of the classical stroke syndromes previously described on clinical and pathological basis to be confirmed, and many new stroke syndromes have been described.

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