Neurovascular

Stroke Vascular Territory Mapper

Map symptoms to arterial territories. Each territory has a characteristic syndrome, sparing pattern, and acute management approach. The localization logic that separates anterior from posterior circulation saves lives.

Clinical Presets

Vascular Territory

Clinical Vignette

NIHSS ~12Window: Last known normal 45 minutes ago

A 72-year-old with atrial fibrillation develops sudden right face and arm weakness with effortful, nonfluent speech. She understands commands. Right leg is strong. 'Tell me your name.' → '...my...name...is...uh...'

Middle cerebral artery — superior division

anterior

Parent: Internal carotid artery

Supplied structures

  • Lateral frontal lobe (motor strip — face and arm representation)
  • Broca's area (dominant hemisphere)
  • Frontal eye field
  • Anterior parietal cortex (sensory strip — face and arm)

MCA Superior Division Syndrome

Contralateral face and arm weakness > leg, with Broca's aphasia if dominant hemisphere

Signs

Contralateral face and arm weakness (leg relatively spared)

contralateral

The homunculus places face and arm laterally on the convexity (MCA territory); the leg is medial (ACA territory).

Broca's (expressive/nonfluent) aphasia

contralateral

Broca's area in the inferior frontal gyrus is supplied by MCA superior division. Nonfluent, effortful speech with relatively preserved comprehension.

Contralateral face and arm sensory loss

contralateral

Anterior parietal cortex (postcentral gyrus) face/arm representation is in MCA territory.

Conjugate gaze deviation toward the lesion

ipsilateral

Frontal eye field damage: eyes deviate toward the lesion (away from the weak side). 'Eyes look at the lesion' in cortical stroke.

What is SPARED

  • Leg strength (ACA territory)
  • Visual fields (PCA territory)
  • Comprehension (Wernicke's in inferior division)

Mimics

  • Hemiplegic migraine (resolves, family history)
  • Todd's paralysis (postictal, preceded by seizure)
  • Conversion disorder (inconsistent exam, give-way weakness)

Acute Management

  • IV alteplase within 4.5 hours (or mechanical thrombectomy up to 24h for large vessel occlusion)
  • NIHSS scoring for severity
  • CT head (rule out hemorrhage) → CTA (identify occlusion)
  • Admit to stroke unit

Variants

  • Isolated Broca's aphasia without significant weakness (small infarct)
  • Faciobrachial weakness without aphasia (non-dominant hemisphere)