Can you elaborate on the common clinical presentations seen with specific arteries affected in a stroke?
Let's review some definitions first so we are all on the same page. Ischemic strokes are due to an obstruction in the vasculature preventing the brain tissue from getting oxygen and nutrients. These obstructions can include blood clots or fatty buildup.
Hemorrhagic strokes are due to blood vessel rupture or leakage causing blood flow into the brain tissue, which causes cell death. This can be due to aneurysms or weakness in the vessel wall, uncontrolled hypertension, and the overuse of medications like anticoagulants. Per Tsao et al., 2022, Eighty-seven percent of all strokes are ischemic, and 13% are hemorrhagic. Hemorrhagic strokes are more severe and have worse outcomes than ischemic ones.
Most clinical presentations do not fit into a nice little box, as with all neurological conditions. It is nice to have basic knowledge about what to expect to help guide your evaluation process and decision-making.
Posterior Cerebral Artery (PCA)
•Branches from the basilar artery
•Supplies occipital and temporal lobes, thalamus
•Contralateral strength and sensory loss
•Aphasia with L PCA strokes
•Neglect with R PCA strokes
Vertebral Arteries/ Basilar Artery
•Vertebral arteries join to form the basilar artery
•Supplies the posterior portion of the brain, including the cerebellum and brainstem
•Vertigo, visual deficits, speech deficits, balance and coordination deficits, including ataxia with cerebellar strokes
•Strength, sensation, vision, swallowing, breathing, and arousal deficits with brain stem strokes
Middle Cerebral Artery (MCA)
•Largest vessel branching from the internal carotid artery
• Supplying large areas of the frontal/temporal/ parietal lobes and basal ganglia
•Contralateral strength and sensory loss in face/arms > legs
•Contralateral homonymous hemianopia •Aphasia with L sided MCA strokes •Neglect with R sided MCA strokes
Anterior Cerebral Artery (ACA)
•Branching from the internal carotid artery
•Supplies portions of the frontal and parietal lobes
•Contralateral strength and sensory loss in legs > arms
•Confusion, delayed response times, memory deficits
This Ask the Expert is an edited excerpt from the course, 4607 Interdisciplinary Approach To Stroke Rehabilitation: Acute Care And Inpatient Rehabilitation Phase by Alaena McCool, MS, OTR/L, CPAM and Katherine George, PT, DPT.