Strokes involving the vertebral-basilar vessels or branches
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Blocked Vessel/ Branch
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Deficit Pattern
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One vertebral artery in the rostral medulla, or in some cases its PICA branch |
termed "Wallenberg's syndrome • sensory loss on ipsilateral side of face but contralateral trunk and limbs • ipsilateral ataxia • ipsilateral Horner's syndrome • ipsilateral vocal cord paralysis • hoarseness • impaired swallowing • vertigo, nausea, vomiting |
| Penetrating paramedian basilar branches in pons | pure motor stroke • contralateral hemiplegia • involvement of face depends on infarction location |
| Basilar occlusion affecting the rostral pons bilaterally | termed "locked-in syndrome" • complete bilateral paralysis rendering patient motionless and mute yet capable of perceiving sensory stimuli • vertical components of 3rd and 4th nerve function may be spared |
| Penetrating PCA branches supplying thalamus | • pure sensory loss • involves face, arm, trunk and leg • initially hemianesthesia but may eventually develop into thalamic pain syndrome with painful dysesthesias in affected parts |
| Unilateral cortical branches of PCA supplying occipital lobe | • contralateral homonymous hemianopsia • may have macular sparing (central vision) depending on location of PCA-MCA border zone |
| Bilateral occlusion of all PCA cortical branches distal to thalamic penetrators | • inability to form and/or consolidate new memories • cortical blindness; in acute stage, possible denial of any vision problem |