What do you need to know about the paralysis of your patient to shorten the list of possible stroke locations?
- Is the paralysis proportionately affecting arm and leg (brachiocrural) or more brachially or crurally or even a monoparesis?
- Does it affect proximal or distal muscles or both?
- How much and in what form is the face affected? Is the face afflicted during volontary and/or emotional innervation?
- Is it purely motor? Is an associated sensory disturbance ipsi- or contralateral? Dissociated?
- What cranial nerves are involved?
We discuss the anatomy of the corticospinal and corticobulbar (in particular the corticofacial) tracts, moving through the various levels
- Cortical: primary motor cortex, sensory cortex, premotor cortex
- Internal capsule
- Cerebral peduncle
We spend some time on the anatomy of the internal capsule – here, the centuries-old descriptions have been reconfirmed in tractography studies.
- Monoparesis is rarely if ever capsular or subcapsular.
- Pure motor proportionate paralysis tends to be capsular.