Lacunar Artery Strokes
Ax - hypertensive haemorrhagic strokes; the lenticulostriate a. are affected
Thalamus – receives contralateral sensory input
Internal capsule
Anterior Limb – carries motor signals from the motor cortex to the medulla and then to the
corticospinal tract
Posterior Limb – works with the thalamus with sensory stuff
Basal Ganglia – contralateral balance and coordination
Thalamus + Posterior Limb Stroke – contralateral sensory loss
Anterior Limb stroke – contralateral motor loss
Basal Ganglia stroke – contralateral ataxic hemiparesis
Basilar Artery Strokes
Supplies most of the posterior circulation apart from the blood received by the posterior
communicating arteries
Supplies the medulla, pons, and corticospinal tracts running down
Cerebellar ataxia due to cerebellum being affected
Global motor loss as pontine and medullary blood flow is affected and hence, the
corticospinal tract is messed up
Frontal lobe remains intact locked in syndrome
Brainstem Strokes
Have more generalised features and CN involvement is common
There are three parts: midbrain, pons, medulla
Blue: Dorsal column medial lemniscus pathway, carries light touch, vibration and
proprioception; there are two posterior spinal a
Red: Corticospinal tract
Green: Anterolateral corticospinal tract and spinothalamic tract (carries fine touch, pain,
temperature)
Rule of 4’s
CN divisible by 12 aka 3, 4, 6, 12 are midline while 5, 7, 8, 9, 10, 11 are lateral
The 4 motor syndromes are midline
The 4 sensory syndromes are to the side (lateral)
Four medial structures:
Ax - hypertensive haemorrhagic strokes; the lenticulostriate a. are affected
Thalamus – receives contralateral sensory input
Internal capsule
Anterior Limb – carries motor signals from the motor cortex to the medulla and then to the
corticospinal tract
Posterior Limb – works with the thalamus with sensory stuff
Basal Ganglia – contralateral balance and coordination
Thalamus + Posterior Limb Stroke – contralateral sensory loss
Anterior Limb stroke – contralateral motor loss
Basal Ganglia stroke – contralateral ataxic hemiparesis
Basilar Artery Strokes
Supplies most of the posterior circulation apart from the blood received by the posterior
communicating arteries
Supplies the medulla, pons, and corticospinal tracts running down
Cerebellar ataxia due to cerebellum being affected
Global motor loss as pontine and medullary blood flow is affected and hence, the
corticospinal tract is messed up
Frontal lobe remains intact locked in syndrome
Brainstem Strokes
Have more generalised features and CN involvement is common
There are three parts: midbrain, pons, medulla
Blue: Dorsal column medial lemniscus pathway, carries light touch, vibration and
proprioception; there are two posterior spinal a
Red: Corticospinal tract
Green: Anterolateral corticospinal tract and spinothalamic tract (carries fine touch, pain,
temperature)
Rule of 4’s
CN divisible by 12 aka 3, 4, 6, 12 are midline while 5, 7, 8, 9, 10, 11 are lateral
The 4 motor syndromes are midline
The 4 sensory syndromes are to the side (lateral)
Four medial structures:
