Clinical stroke syndromes: clinical-anatomical correlations.

Abstract

The vascular territories of the major cerebral arteries supplying the cerebral cortex, subcortical structures, cerebellum, and brainstem in humans are relatively uniform. Because of their anatomical distribution, and the specialized neurologic functions located within these territories, infraction due to arterial occlusion gives rise to distinct clinical syndromes. Thus, the physical findings on neurologic examination permit a reliable topographic diagnosis. With extensive infraction involving all or major portions of a particular vascular territory, the resultant clinical syndromes tend to be severe, reflecting the large area of involvement. More typically, however, infarcts do not involve a vascular territory in its entirety but are limited to the distribution of secondary branches by various mechanisms of arterial occlusion. Depending on their location, these smaller infarcts produce syndromes that may vary in severity and manifestations. Our understanding of the clinical approach of clinicoanatomical correlations in these forms of cerebral infarction has been facilitated by the widespread use of brain CT and MRI scans, that have virtually replaced the classical approach of clinicopathological correlations in autopsy material. In this review we have divided the manifestations of occlusive cerebrovascular disease according to the vascular territories affected. The distinct clinical syndromes which thus arise and their common mechanisms are described. Correlation is made with the typical CT and MRI images.