Examination of the Patient with Cerebrovascular Disease
Goals
Immediate information about size, location, etiology of stroke, to guide acute treatment.
Establish site and number of suspected lesions, which may not be visible on initial imaging.
Syndromes Suggesting Specific Etiologies
Wernicke aphasia, homonymous hemianopia, top-of-the-basilar syndrome (cortical blindness, agitation, ocular dysmotility, amnesia): cardiac embolism.
Lateral medullary syndrome (Wallenberg syndrome; see Chapter 39, Table 39.2): vertebral artery thrombosis.
Lacunar syndromes (Chapter 39): lipohyalinosis, fibrinoid necrosis of small deep penetrating arterioles.
Gaze deviation, hemiparesis (opposite to gaze), altered mentation: common manifestation of large infarct. If mentation normal, patient still at high risk of acute worsening during first week with cerebral edema.
Gaze deviation, hemiparesis (same side as gaze): lateral pons.
Aphasia, hemineglect: cortical involvement.
Findings with Localizing Value
General Examination
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