Ischemic Stroke


  • Embolic: artery → artery, cardioembolic (~30% due to AF; NEJM 2014;370:2478), paradoxical
  • Thrombotic: large vessel (atherosclerosis) vs. small vessel (“lacunar,” lipohyalinosis of small arteries, often related to smoking, HTN, hyperlipidemia, & DM)
  • Other: dissection, vasculitis, vasospasm, hypercoag, hypoperfusion, endocarditis, venous

Clinical manifestations

  • Timing: embolic → sudden onset; thrombotic → may have stuttering course
Stroke Syndromes by Vascular Territory
Artery Deficits
ICA → Ophth Amaurosis fugax (transient monocular blindness)
ACA Hemiplegia (leg > arm), abulia, urinary incontinence, primitive reflexes
MCA Hemiplegia (face & arm > leg); hemianesthesia; homonymous hemianopia