Dysarthria-clumsy hand syndrome localizes to the genu of the internal capsule. Pure sensory stroke localizes to the ventral posterior thalamus. Pure motor stroke localizes to the posterior limb of the internal capsule. PICA originates from the vertebral artery; AICA originates from the basilar artery. Mastoid ecchymosis with otorrhea and facial nerve palsy indicates petrous or temporal bone fracture. Venous sinus thrombosis requires anticoagulation plus aggressive IV fluid resuscitation.

Dysarthria-clumsy hand syndrome: lesion in the genu of the internal capsule.Pure sensory stroke: lesion in the ventral posterior thalamus.Pure motor stroke: lesion in the posterior limb of the internal capsule.PICA originates from the vertebral artery; supplies the lateral medulla and lower cerebellum.AICA originates from the basilar artery.Wallenberg syndrome (lateral medullary infarct): hoarseness, dysphagia, sensory loss, ipsilateral Horner's syndrome.Locked-in syndrome: quadriplegia with preserved vertical eye movements.Benedict syndrome: ipsilateral oculomotor palsy with contralateral tremor.Millard-Gubler syndrome: ipsilateral CN6 and CN7 palsy with contralateral hemiplegia.Mastoid ecchymosis, otorrhea, and facial nerve palsy indicate temporal or petrous bone fracture.Venous sinus thrombosis treatment: anticoagulation plus aggressive IV fluid resuscitation (normal saline bolus then 2-3 cc/kg/hour).