How is vertebrobasilar stroke differentiated from hemispheric stroke?

Updated: Mar 03, 2020
  • Author: Vladimir Kaye, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Lesions in the vertebrobasilar system have some characteristic clinical features that distinguish them from lesions in the hemispheres, including the following [1] :

  • When cranial nerves or their nuclei are involved, the corresponding clinical signs are ipsilateral to the lesion and the corticospinal signs are crossed, involving the opposite arm and leg

  • Cerebellar signs (eg, dysmetria, ataxia) are frequent

  • Involvement of the ascending sensory pathways may affect the spinothalamic pathway or the medial lemniscus (dorsal columns), resulting in dissociated sensory loss (ie, loss of 1 sensory modality on one side and preservation of other sensory modalities in the opposite limbs)

  • Dysarthria and dysphagia typically are present

  • Vertigo, nausea, and vomiting, along with nystagmus, represent involvement of the vestibular system

  • Unilateral Horner syndrome occurs with brainstem lesions

  • Occipital lobe lesions result in visual field loss or visuospatial deficits

  • Cortical deficits, such as aphasia and cognitive impairments, are absent

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