2. DEFINATION
Stroke or brain attack is the sudden loss of neurological
function caused by an interruption of the blood flow to
the brain.
Classification:
Ischemic stroke : is the most common type results
when a clot blocks or impairs blood
flow, depriving the brain of essential
oxygen and nutrients.
Hemorrhagic stroke: occurs when blood vessels rupture,
causing leakage of blood in or
around the brain.
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7. EPIDEMIOLOGY
• Third leading cause of death
• Most common cause of disability among
adults in U.S
• The incidence is about 1.25 times greater for
males then females M>F
• Compared to whites, African-Americans have
twice the risk of first ever stroke
11. PATHOPHYSIOLOGY
Interruption of blod flow
Complete cerebral circulatory arrest
Irreversible cellular damage with core area of
Ischemic
Ischemic
focal infarction
cascade
penumbra
Release of excess neurotransmitters
(glutamate and aspartate)
Damage brain cells
12. TRANSIENT ISCHEMIC ATTACK (TIA)
• Temporary interruption of blood supply to the brain.
• Symptoms last for only a few minutes or for several
hours
• Not last longer then 24 hours
• No evidence of residual brain damage or permanent
neurological dysfunction
• Etiological factors: occlusive episodes, emboli,
reduced cerebral perfusion(arrhythmias, decreased
cardiac output, hypotension, overmedication with
antihypertensive medication or cerebrovascular spasm
13. WARNING SIGNS OF STROKE:
• Sudden numbness or weakness of the face, arm
or leg esp on one side of the body
• Sudden confusion, trouble speaking or
understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance
or coordination
• Sudden, severe headaches with no known cause
14. ACA syndrome
ACA is the smaller terminal branch of the internal
carotid artery.
• Supplies:
• Medial aspect of cerebral hemisphere(frontal &
parietal lobes)
• Sub cortical structures BG ( anterior internal
capsule, inferior caudate nucleus, anterior 4/5th
of corpuscallosum)
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18. Signs and symptoms :
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Contra lateral hemi paresis (LE > UE)
Contra lateral hemi sensory loss (LE > UE )
Urinary incontinence
Problems with imitation and bimanual tasks,
apraxia
Structures involved :
• Primary motor area, medial aspect of cortex,
internal capsule
• primary sensory area
• Posteriomedial aspect of superior frontal gyrus
• corpus callosum
19. MCA syndrome
MCA is the second of the two main branches of the
internal carotid artery.
Supplies:
• Lateral aspect of cerebral hemisphere( frontal,
temporal, and parietal lobes )
• Subcortical structures (IC, corona radiata , globus
pallidus, putamen )
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22. Signs and symptoms:
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Contralateral hemiparesis (UL and face > LL)
Contralateral sensory loss (UL and face > LL)
Motor speech impairment
Receptive speech impairement
Global aphasia
Perceptual deficits (unilateral neglect, anosognosia,
apraxia and spatial disorganization)
• Contralateral homonymous hemianopsia
• Sensory ataxia
Structures involved :
Primary motor area, primary sensory area, broca’s area,
Wernicke’s area, optic radiation in internal capsule
23. PCA syndrome
PCA is the terminal branches of the basilar artery.
Supplies:
• Occipital lobe
• Medial & inferior temporal lobe
• Upper brainstem
• Most of thalamus
26. Vertebrobasilar artery syndrome
1. Medial medullary syndrome( Dejerine
syndrome)
Signs and symptoms
• Ipsilateral: paralysis with atrophy of half tongue with
deviation to the paralyzed side when tongue is
protruded
• Contralateral:
Paralysis of UE and LE
Impaired tactile & proprioceptive sense(medial
lemniscus)
Structures involved
CN XII, corticospinal tract or medial lemniscus
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28. 2. Lateral medullary Syndrome (Wallenberg’s
syndrome):
Signs and symptoms
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Ipsilateral:
Decreased pain & temp sensation over face(V n.)
Ataxia of limbs and gait
Vertigo, nausea, vomitting, nystagmus
Horner’s syndrome: miosis, ptosis, decreased
sweating(sympathetic tract)
Dysphagia, hoarsness of voice, paralysis of vocal cord(IX, X n.)
Sensory impairment of ipsilateral UE, trunk, or LE
• Contralateral :
Impaired pain and thermal sense over 50% of body
Structures involved
CN V, Cerebellum, vestibular nuclei, descending sympathetic tract,
CN IX
29. 3. Complete basilar artery syndrome ( locked-in
syndrome )
Signs and symptoms
• Tetraplegia
• Bilateral cranial nerve palsy
• Coma
• Cognition is spared
Structures involved
• Corticospinal tracts bilaterally
• Long tracts to cranial nerve nuclei bilaterally
• Reticular activating system
30. 4.Medial inferior pontine syndrome:
Signs and symptoms
• Ipsilateral:
Nystagmus
Ataxia of limb & gait
Diplopia on lateral gaze(6th n.)
Paralysis of conjugate gaze to side of lesion
• Contralateral:
Paresis of face, UE and LE
Impaired tactile & proprioceptive sense over 50 % of the body
Structures involved
Vestibular connections, middle cerebellar peduncle, CN VI,
corticobulbar and corticospinal tract
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32. 5.Lateral inferior pontine syndrome:
Signs and symptoms
• Ipsilateral:
Nystagmus,vertigo,nausea,vomitting (vest. N.)
Facial paralysis(7th n.)
Ataxia(cerebellar peduncle)
Impaired sensation over face(5th n.)
• Contralateral:
Impaired pain & thermal sense over half the
body(spinothalamic tract)
33. 6. Medial midpontine syndrome
Signs and symptoms
• Ipsilateral:
Ataxia of limb & gait (middle cerebellar peduncle)
• Contralateral:
Paralysis of face,arm,leg(CST, corticobulbar tract)
Deviation of eyes
7. Lateral midpontine syndrome
Signs and symptoms
• Ipsilateral:
Ataxia of limbs( middle cerebellar peduncle)
Paralysis of muscles of mastication( CN V)
Impaired sensation over face(CN V )
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35. 8. Lateral superior pontine syndrome
Signs and symptoms
• Ipsilateral:
Ataxia of limb & gait(middle cerebellar peduncle)
Dizziness, nausea, vomiting, nystagmus( vest nuc)
Horner’s syndrome( desc symp tract)
• Contralateral:
Impaired pain, thermal sense (spinothalamic tract)
Impaired touch, vibration & position sense(medial
lemniscus)
9.Medial superior pontine syndrome
Signs and symptoms
Cerebellar ataxia( Sup and midd cerebellar peduncle )
Paralysis of face, UE and LE( CST & CBT)
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37. PRIMARY IMPAIRMENTS
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SENSATION
Rarely absent
Impaired
Most common distribution pattern: face-UL-LL
Proprioceptive losses common
Loss of superficial touch and pain and temp
sensation common
• Abnormal sensations such as numbness,
dysesthesias, or hyperesthesia
• Profound hemisensory loss
38. 2. PAIN
• Ischemic stroke or hemorrhagic stroke result
severe headache and face pain.
• Post stroke thalamic pain characterised by :
• Constant, severe burning pain with intermittent
sharp pains.
• Paroxysmal spasms of pain may be triggered by
simply stroking , pin prick, heat or cold
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VISUAL CHANGES
Homonymous hemianopsia
Visual neglect
Forced gaze deviation
42. 7. ABNORMAL REFLEXES
• Hyporeflexia with flaccidity & hyperreflexia with
spasticity
• Primitive reflexes
• Associated reactions
8. ALTERED COORDINATION
9. ALTERED MOTOR PROGRAMMING
10. POSTURAL CONTROL AND BALANCE
• Ipsilateral pushing ( pusher syndrome )
Is an unusal motor behaviour characterised by
active pushing with the stronger extremities
toward the hemiparetic side, leading to a lateral
postural imbalance
