Stroke and Cerebral Ischemia

Cerebral infarction can occur in the brain stem and cerebellum. Patients with cerebellar infarcts commonly present with ataxia due to occlusion of one of the major arteries supplying the cerebellum. Occlusion of the posterior inferior cerebellar artery results in the classic Wallenberg's (lateral medullary) syndrome, which consists of dysfunction of the ipsilateral lower cranial nerves, an ipsilateral horner's, decreased contralateral pain and temperature sensation, and ataxia.

The brain stem is supplied by multiple small perforating arteries arising from the basilar artery and its major branches. Occlusion of one of these arteries results in a lacunar infarct. Symptoms are quite variable and may include cranial nerve palsies and long tract signs related to involvement of the major fiber tracts that course through the brain stem. 

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