Symptoms and signs of posterior cerebral artery and internal carotid artery occlusions
1. Big picture
This topic is mainly about clinical localization in ischemic stroke. The examiner wants you to recognize two important arterial patterns:
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Posterior cerebral artery (PCA) occlusion → mainly causes visual cortical symptoms, especially contralateral homonymous hemianopia, plus possible thalamic, memory, and midbrain signs depending on the branch involved.
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Internal carotid artery (ICA) occlusion → affects the anterior circulation, often producing a large hemispheric stroke pattern involving middle cerebral artery (MCA) ± anterior cerebral artery (ACA) territory, with possible amaurosis fugax because the ophthalmic artery arises from the ICA.
The key exam logic is:
Monocular transient blindness = retina / ophthalmic artery / ipsilateral ICA problem. Homonymous hemianopia = retrochiasmal lesion, often PCA/occipital cortex. Face-arm dominant hemiparesis = MCA. Leg-dominant hemiparesis = ACA. Face, arm, and leg similarly affected = consider ICA or internal capsule.
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