Vascular territories of the brain and clinical features of stroke

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ACA:  The ACA runs along the midline of the brain and supplies  medial part of the motor and sensory homunculus therefore occlusion may result in contralateral motor and sensory loss in the legs. Not common to get isolated ACA involvement. 

MCA:  Most commonly involved in strokes. Supplies motor and sensory cortex. In the dominant hemisphere it supplies Broca’s and Wernicke’s points (expression and comprehension of speech respectively). In the non dominant hemisphere it supplies visuospacial tasks. 

Therefore, clinical features include:

•Contralateral hemiplegia with relative sparing of the legs (ACA territory)

• UMN signs

•contralateral hemisensory loss

•aphasia if dominant hemisphere affected

• neglect and contralateral apraxia if non dominant hemisphere affected

PCA:  Arises from the basilar artery and  supplies midbrain, thalamus, temporal and occipital lobes.

 Clinical features include: thalamic syndrome (excessive pain), homonymous hemianopia with macular sparing,  contralateral hemiplegia,  hemisensory disturbance and dyskinesias.

Lacunar infarcts: Infarcts in important small vessels which supply structures such as the internal capsule which connects spinal cord to the cortex. Small infarcts can lead to significant damage such as contralateral hemiparesis.