Table 4.

Lesion location, cognitive syndrome, and cardiovascular etiology

Location or territory	Cognitive syndrome and features	Memory pattern	Cardiovascular etiology
Anterior cerebral artery (medial frontal, cingulate, supplementary motor area, anterior corpus callosum)	Abulia, akinetic mutism if bilateral, transcortical motor aphasia (dominant), apathy and executive impairment, contralateral leg-predominant weakness, alien limb with callosal involvement	Retrieval and organizational (frontal) pattern, lesion-dependent	Cardioembolic or large-artery atherosclerotic infarct; anterior watershed hypoperfusion
Middle cerebral artery (lateral fronto-temporo-parietal cortex; deep territory via lenticulostriates)	Dominant: Broca, Wernicke, or global aphasia, apraxia. Nondominant: hemispatial neglect, anosognosia, aprosodia. Either: contralateral hemiparesis, hemianopia	Lesion-dependent, not primarily amnestic	Cardioembolic (the most common recipient territory, the principal atrial fibrillation link), large-artery atherosclerosis, carotid artery-to-artery embolism
Posterior cerebral artery (occipital cortex, medial temporal and hippocampus, splenium, thalamic perforators)	Homonymous hemianopia, visual agnosia, prosopagnosia, alexia without agraphia (dominant, with splenium), Balint syndrome and Anton syndrome if bilateral	Encoding-type amnesia if medial temporal involved, dense and Alzheimer-like when bilateral	Cardioembolic, including top-of-basilar embolism; vertebrobasilar atherosclerosis
Paramedian thalamus, with or without rostral midbrain	Amnesia, executive impairment, fluctuating arousal, apathy, vertical gaze palsy	Encoding-type	Small-vessel occlusion of thalamoperforators, or embolic occlusion of the artery of Percheron
Caudate or anterior capsular genu	Abulia, dysexecutive syndrome, psychomotor slowing	Retrieval-type	Small-vessel lacunar infarct, or cardioembolic
Dominant angular gyrus	Alexia, agraphia, acalculia, finger agnosia, left-right disorientation (Gerstmann), can mimic Alzheimer disease	Variable	Cardioembolic or large-artery infarct in the MCA inferior division (angular branch)
Deep frontal-subcortical white matter	Slowed processing, executive dysfunction, apathy, early gait disorder, urinary urgency	Retrieval-type, cueing helps	Small vessel disease (arteriolosclerosis), chronic and insidious
Posterior (parieto-occipital) watershed	Balint syndrome: simultanagnosia, optic ataxia, ocular apraxia; visual disorientation	Not a distinguishing feature	Global hypoperfusion: cardiac arrest, severe hypotension, low output
Anterior (frontal) watershed	Executive impairment, transcortical motor aphasia, proximal-predominant (man-in-a-barrel) weakness	Not a distinguishing feature	Global hypoperfusion
Hippocampus (CA1)	Dense anterograde amnesia mimicking Alzheimer disease	Encoding-type, poor cueing benefit	Global hypoxic-ischemic injury (cardiac arrest), selective CA1 vulnerability
Basal ganglia and cerebellum	Parkinsonism, dystonia, action myoclonus	Not a distinguishing feature	Global hypoxic-ischemic injury