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Symptoms of Carotid Strokes

Common strokes involving the carotid artery or its branches

We will consider the following five Stroke Syndromes produced by occlusion of the internal carotid and its branches because they are the most common, and therefore the most important to understand. 

Blocked Vessel or Branch
Patterns of Possible Deficits
Extracranial Internal Carotid
  • Deficits depend on the extent of collateral supply and how quickly occlusion occurred. As many as 30-40% of carotid occlusions near the bifurcation are clinically silent.
MCA-main stem (M1)
  • Contralateral hemiplegia and hemisensory loss
  • Contralateral hemianopsia
  • Global aphasia (L)* or denial, neglect, and disturbed spatial perception perhaps with emotional 'flatness' (R)*
  • Eye and head deviation toward lesion in acute stage
MCA-superior cortical division
  • Contralateral Hemiparesis and hemisensory loss (face and arm more than leg; often motor more than sensory)
  • Expressive (Broca's) aphasia (L)* or neglect and disturbed spatial perception (R)*
  • Eye and head deviation toward lesion in acute stage
MCA- inferior cortical division
  • Receptive (Wernicke's) aphasia (L) or denial, neglect and disturbed spatial perception (R)*
  • Contralateral hemianopsia-usually upper quadrants are most affected
MCA-lenticulostriate branch
  • "Pure motor" stroke often, but not necessarily, involving lower face, arm and leg equally but sparing sensation

*Assuming left hemisphere dominance for language