ANTERIOR

TERRITORY

POSTERIOR

TERRITORY

VERTEBRO-BASILAR

TERRITORY

 These

systems of circulation supply specific regions of the brain Therefore if there is a interruption to the specific blood supply, characteristic symptoms are experienced. This is particularly useful in the clinical scene to locate exactly the position of a lesion or the offending supply.

Interior Carotid Artery Middle Cerebral Artery Anterior Cerebral Artery

Posterior Cerebral Artery

Vertebral arteries

Basilar Artery

Frontal lobe behavioural abnormalities

Loss of motivation Disinhibition

Grasp reflex
Leg Weakness Leg loss of sensation

Contralateral neglect

Contralateral hemiplegia
Contralateral hemiparesis Contralateral hemisensory loss

Visual/sensory neglect/inattention
Visual Field deficit In deep supply (Lenticulostriate arteries): Pure Motor and/or Sensory loss, Dysarthria, Dyspahasia

Contralateral Hemianopia
Dysphasia

Contralateral homonymous hemianopia.

Contralateral hemiparesis Contralateral hemisensory loss. Alexia without agraphia. Dysphasia

Dysarthria Cerebellar ataxia Cortical blindness Impaired consciousness Locked-in syndrome

Dysphagia

Long tract motor & sensory signs

Cranial nerve abnormalities

Dysdiadokokinesia Tremor, Cerebellar ataxia Vertigo Locked-in syndrome Nausea and vomiting

Nystagmus Impaired consciousness Respiratory arrest Autonomic instability Contralateral sensory and motor loss Dysarthria Dysphagia Long tract motor & sensory signs

1.

Total Anterior Circulation Stroke TACS

Partial Anterior Circulation Stroke PACS Lacunar Stroke - LACS Posterior Circulation Stroke POCS

2.

3.

4.

All of: 1. New higher cerebral dysfunction in the affected hemisphere (e.g. Dysphasia, inattention, neglect, dyspraxia , Visual field defect) 2. Contralateral hemiplegia and hemiparesis. Motor and / or sensory deficit of at least two areas out of face, arm and leg. 3. Contralateral hemianopia

*If drowsy with unilateral weakness, last two factors are assumed

Any of: No Drowsiness 2 out of 3 criteria of TACS OR Isolated Higher cerebral dysfunction alone (eg dysphasia) OR Motor/sensory deficit more restricted than those classified as LAC (eg confined to one limb)(Monoplaegia)

NO visual field defect NO disturbance of language or other higher cortical function NO evidence of brainstem dysfunction
Types: 1. Pure Motor Stroke(most common). Complete or incomplete weakness of 1 side, involving the whole of 2 of 3 of the body areas of face, arm and leg).
2.

Pure Sensory Stroke. Sensory symptoms and/or signs, same distribution as above. Ataxic Hemiparesis (inc. dysarthria-clumsy hand) . Hemiparesis with ipsilateral cerebellar ataxia Sensorimotor Stroke. Combination of the above. Includes dysarthria (clumsy hand syndrome) and dysphasia

3.

4.

Any of Dysfunctions of the brainstem, cerebellar or occipital lobes(cortical blindness) Ipsilateral cranial nerve palsy with contralateral motor and / or sensory deficit Bilateral motor and / or sensory deficit. Disorder of conjugate eye movement Isolated homonymous visual field defect Cerebellar dysfunction without ipsilateral long tract signs (ataxia)

Robin Smithuis. Brain Ischemia - Vascular territories. The Radiology Assistant, 24-112008[online]. http://www.radiologyassistant.nl/en/484b8328c b6b2. Accessed 04/05/2012 Iain Wilkinson and Graham Lennox. Essential Neurology 2005 by Blackwell Publishing Ltd. BLUMENFELD, H. Neuroanatomy Through Clinical Cases 1st edition. 2002 by Sinauer Associates. Seminar: Stroke by Dr Paul Worth. 3rd May 2012. 1100hrs CD ANNEX 0.01 Norwich Medical School.