Signs and symptoms of cerebral lesions

Created 12/09/2023, last revision 12/09/2023

behavioral symptoms (prefrontal sy)
- altered personality
- emotional lability
- disinhibition and socially inappropriate behavior
- abulia or loss of will, particularly when the lesion involves the medial frontal regions
motor symptoms:
- hemiparesis when motor areas are involved
- altered speech production in lesions affecting Broca’s area in the dominant hemisphere
cognitive symptoms
- executive dysfunction
- memory deficits, particularly working memory
epileptic seizures

bleeding into a dominant hemisphere leads to impaired symbolic functions (aphasia, anosmia, acalculia, alexia, agraphia, apraxia, etc.)
sensory symptoms
- contralateral hemihypesthesia to various sensory modalities
- astereognosis (difficulty in recognizing objects by touch, astereognosis, lesions affecting the postcentral gyrus)
- agnosia for pain or temperature (may also be caused by thalamic lesion)
visuospatial impariment
- contralateral neglect syndrome (usually caused by lesions in the nondominant hemisphere), often accompanied by hemianopsia
- optic ataxia (posterior parietal cortex
- Balint’s Syndrome – a triad of optic ataxia, oculomotor apraxia, and simultanagnosia (more commonly seen in bilateral parietal lesions)
- impaired spatial orientation
cognitive and language impairments
- Gerstmann’s syndrome (includes agraphia, acalculia, finger agnosia, and left-right disorientation; angular gyrus is usually affected)
- anomia (difficulty in naming objects, particularly when the dominant hemisphere is affected)
  - damage to various brain regions rather than a single, well-localized area. Lesions causing can be found in the dominant hemisphere and often involve the angular gyrus, the middle and inferior temporal gyri, or regions of the frontal lobe, specifically the dorsolateral prefrontal cortex

homonymous hemianopsia
cortical blindness (complete loss of vision with preservation of pupillary light reflex and intact ocular structures)
visual agnosia – inability to recognize visually presented objects despite intact vision
Anton-Babinski Syndrome – a rare neurological condition characterized by cortical blindness with the paradoxical denial of visual loss (agnosia)
Reverse Anton Syndrome – patients claim to be blind but actually have preserved vision
achromatopsia – inability to perceive color
palinopsia – abnormal persistence or recurrence of visual images
Balint’s Syndrome (usually involves parieto-occipital lesion)

large hematomas can quickly lead to temporal conus syndrome
epileptic seizures
Wernicke’s aphasia – impaired comprehension and fluent but nonsensical speech output (superior temporal gyrus in the dominant hemisphere)
auditory agnosia – difficulty in recognizing sounds despite intact hearing
memory impairments
complex focal seizures

typical hypertensive bleeding is caused by a rupture of the lenticulostriate artery (LSA)
severe hemiparesis or hemiplegia with hemisensory deficit (due to lesion of the internal capsule)
dysarthria
impaired level of consciousness (sign of rostral brainstem involvement)
hyperkinetic movements (tremor, chorea, balism)
impaired saccadic or smooth pursuit eye movements
cognitive impairment

thalamic hemorrhage usually affects the diencephalon and mesencephalon directly or by compression
contralateral hemihypesthesia and hemiparesis (less prominent unless the internal capsule is involved)
oculomotor dysfunction due to cranial portion
- skew deviation (deviation of one eye upward, the other downward); more commonly seen in brainstem lesions
- upward gaze palsy (due to the disruption of the thalamocortical or brainstem-thalamic pathways)
- impaired smooth pursuit movements (the thalamus has connections with the parietal and occipital lobes that are involved in visual tracking)
thalamic neglect syndrome (right) or aphasia (left) and thalamic pain
even a small-volume thalamic hematoma can lead to aqueduct blockage or transtentorial herniation

neocerebellar and/or paleocerebellar syndrome (ataxia, dysmetria, dysdiadochokinesia, intention tremor, hypotonia)
dysarthria
nystagmus
nausea, vomiting, and headache due to intracranial hypertension
in larger hematomas with brainstem compression, hemiparesis and cranial nerve palsy may occur
altered level of consciousness (LOC) and breathing disorders usually depend on the size of the hematoma and the degree of brainstem compression
executive dysfunction

mesencephalic hemorrhages are typically small
- oculomotor paresis, varying degrees of various pathways involvement
pontine hemorrhages are divided according to their localization into basal-tegmental, bilateral tegmental, massive, and small unilateral tegmental [Chung, 1992]
- decreased level of consciousness (most common)
- bulbar and respiratory dysfunction, bradycardia, quadriplegia, cranial nerve palsies
- risk of CSF blockade with the development of acute obstructive hydrocephalus
- extensive pontine hemorrhage has a poor prognosis
primary bleeding into the oblongata leads to bulbar symptomatology, often hemiparesis, cerebellar ataxia due to pathway involvement, and possibly respiratory dysfunction
hemorrhages in the posterior fossa may be associated with persistent, days-lasting hiccups, which may contribute to the worsening of respiratory insufficiency

→ Brainstem syndromes
→ Brainstem reflexes