m Is the sudden loss of neurological function

caused by an interruption of the blood flow to

the brain

m Variety of focal deficits are possible, including

changes in the level of consciousness and
impairments of sensory, motor, cognitive,
perceptual and language functions.
m ISCHEMIC STROKE ² is the most common type,
affecting about 80% of individuals with stroke,
and results when a clot blocks or impairs blood
flow, depriving the brain of essential oxygen and
nutrients.
CEREBRAL THROMBOSIS- refers to the formation or
development of an atherosclerotic plaque within the
cerebral arteries or their branches.
CEREBRAL EMBOLUS- are travelling bits of matter
formed elsewhere that are released into the
bloodstream and travel to a cerebral artery, where they
lodge in a vessel, producing occlusion and infarction.
m Atherosclerosis
m Hardening or loss of elasticity of vessel
m Plaques which can lead to thrombus .
m HEMORRHAGIC STROKE- occurs when blood
vessels rupture, causing leakage of blood in or
around the brain.
INTRACEREBRAL HEMORRHAGE- rupture of blood
vessel with a subsequent bleeding into the brain.
SUBARACHNOID HEMORRHAGE- occurs from
bleeding into the subarachnoid space typically from a
saccular or berry aneurysm.
ARTERIOVENOUS MALFORMATION- a tortorous
tangle of arteries and veins with an agenesis of an
interposing capillary system.
m Hypertension
m Heart disease
m Diabetes
m COMPLETE STROKE
m STROKE IN EVOLUTION
m TRANSCIENT ISCHEMIC ATTACK (TIA)
m REVERSIBLE ISCHEMIC NEUROLOGIC
DEFICIT (RIND)
m It supplies orbital and medial surfaces of frontal
and parietal lobes.
m INTERRUPTION CAUSES:
ΠCortical arteries
ΠParalysis of legs and feet
ΠDifficulty in prefrontal lobe functions of cognitive
thinking, judgement, motor initiation and self
monitoring.
m SIGNS AND SYMPTOMS:
Paresis of opposite foot and leg more affected than the
arm
Mental impairment (perseveration, confusion and
amnesia)
Sensory impairment primarily on LE
Urinary incontinence
Problems with imitation of bilateral tasks, apraxia,
slowness, delay, lack of spontaneity, motor inaction.
m Primary motor area, medial aspect of cortex,
internal capsule
m Primary sensory area, medial aspect of cortex
m Posteromedial aspect of superior frontal gyrus
m Corpus callosum
m Supplies blood to entire lateral surface of brain.
Somatosensory cortex
Motor cortex
Broca·s area
Heschl·s gyrus
Wernicke·s area

INTERRUPTION CAUSES:
Contralateral hemiplegia
Impaired sensory systems
Touch
m SIGNS AND SYMPTOMS:
Paresis of contralateral face, arm and leg is least affected
Sensory impairment of contralateral side
Expressive aphasia and receptive aphasia
Perceptual deficits
Homonymous hemianopsia
Loss of conjugate gaze to the opposite side
Ataxia or contralateral limb.
m Supplies blood to anterior and inferior temporal
lobes, uncus, inferior temporal gyri, inferior and
medial occipital lobe.
m Watersheds with middle cerebral artery
m Interruption causes:
Homonymous hemianopsia
Possible total blindness
Cerebellar symptoms
m SIGNS AND SYMPTOMS:
ΠContralateral homonymous hemianopsia
ΠContralateral sensory loss
ΠThalamic syndrome
ΠInvoluntary movements (choreoathetosis, intention,
tremor, hemiballismus)
Œ Weber·s syndrome
ΠDyslexia, prosopagnosia, agraphia, anomia
m è
 


 
ΠVisuomotor perception and memory intact
ΠVisual learning
ΠLearning is step by step, encourage imitation
ΠUnable to communicate effectively vocabulary and
auditory span reduced.
ΠAble to pick up ideas through body language and facial
expression.
ΠCautious and unorganized when approaching an unfamiliar
situation.
ΠLearns from mistakes able to synthesize
ÿ. Visuomotor perceptual impairment
2. Loss of visual memory
3. Left sided neglect; impulsive or unorganized activities
of daily living
4. Safety problem with many falls inability to follow
through.
5. Does not learn from mistakes or observing others.
6. Learning is impaired ; persons performance may not
improve.
7. Often battles with staff or premature discharge.
 
  
       
3RD CRANIAL NERVE PALSY ü IPSILATERAL 3RD NERVE
WEBER MEDIAL BASAL CORTICOSPINAL TRACT PALSY
MIDBRAIN ü CONTRALATERAL
HEMIPLEGIA

3RD CRANIAL NERVE PALSY üIPSILATERAL 3RD NERVE PALSY

BENEDIKT TEGMENTUM OF SPINOTHALAMIC TRACT üCONTRALATERAL LOSS OF
MIDBRAIN MEDIAL LEMNISCUS PAIN AND TEMPERATURE
SUP.CEREBELLAR PEDUNCLE SENSATION, LOSS OF JOINT
RED NUCLEUS POSITION, ATAXIA AND
CHOREA.

CORTICOSPINAL TRACT üBILAT, HEMIPLEGIA

LOCKED IN BILAT. PONS CORTICOBULBAR TRACT üBILAT. CRANIAL NERVE PALSY
(UPWARD GAZE SPARED )

6TH CRANIAL NERVE PALSY üIPSILATERAL 6TH NERVE PALSY

MILLARD LATERAL PONS 7TH CRANIAL NERVE PALSY AND FACIAL WEAKNESS
GUBLER CORTICOSPINAL TRACT üCONTRALATERAL
HEMIPLEGIA

SPINOCEREBELLAR TRACT üIPSILATERAL HEMIATAXIA

WALLENBERG LAT. MEDULLA 5TH CRANIAL NERVE PALSY üIPSILATERAL LOSS OF FACIAL
NUCLEUS AMBIGUUS PAIN AND TEMP. SENSATION
SPINOTHALAMIC TRACT üCONTRALATERAL LOSS OF
VESTIBULAR NUCLEI BODY PAIN AND TEMP.
SYMPATHETIC TRACT SENSATION.
üNYSTAGMUS
üIPSILATERAL HORNER·S
SYNDROME
üDYSPHONIA & DYSPHAGIA
m BRAYDYKINESIA
m RIGIDITY: (Lead pipe & Cogwheel rigidity)
m TREMOR (Resting tremor)
m AKINESIA
m CHOREA
m ATHETOSIS
m CHOREOATHEROSIS
m HEMIBALLISMUS
m DYSTONIA
m HYPOTONIA
m DYSMETRIA
m DYSDIADOCHOKINESIA
m TREMOR; Intention tremor & Postural Tremor
m DYSSENERGIA (Movement decomposition)
m DISORDERS OF GAIT
m DYSARTHRIA(SCANNING SPEECH)
m NYSTAGMUS
m REBOUND PHENOMENON
m ASTHENIA
m TRUNKAL AND LIMB ATAXIA
m FATIGABILITY
 inability to generate normal levels of force required in
the muscles for the purposes of posture and movement ; Hemiplegia, Paraplegia,
Tetraplegia, Quadriplegia, Monoplegia

 ! sustained muscle contraction frequently causing twisting, repetitive

movement and abnormal postures ;co-contraction of agonist and antagonist.
focal dystonia ² single body region
segmental dystonia ² two or more adjoining areas
hemidystonia ² one side
multifocal dystonia ² 2 or more nonadjoining areas
generalized dystonia ² involves whole body
"  ² rhythmical involuntary oscillatory movement of
a body part on a fixed point
p
p p ² on the part that is not voluntarily
activated, supported against gravity
 p p ² when part is asked to perform
a specific movement
÷
 p
p p ² unsupported against gravity

!# $!  #"!

chorea ² rapid, random, irregular, jerky
athetosis ² slow, writhing, twisting
Hemiballismus- Exaggerated sudden jerky
movements
upper ex more than lower ex; also on neck, face,
tongue
$%&' Pain, Temperature and Light touch

% ! ! Kinesthesia, Proprioception,Vibration,

Tactile Discrimination, Stereognosis, Bargognosis

($ &' Homonymous Hemianopsia, Cortical

Blindness, Myopia(impaired far vision), Presbiopia
(impaired near vision)

m ()$ &' blurred vision, nystagmus,

oscillopsia (oscillating vision), problems with posture
and balance, vertigo or dizziness
! ! ability to focus on a specific stimulus
without being distracted
focused attention ability to respond to a specific stimulus
sustained stimulus ² ability to maintain attention over time
selective attention ² ability to focus attention in the presence of
distracting stimulus
alternating attention ² ability to shift focus from one task to another
divided attention ² ability to respond simultaneously to multiple tasks
" ability to process, store and retrieve information
Kinds of memory
Immediate Recall
Recent Memory
Remote Memory

$!&' "! a generalized decline in higher

brain functions with faulty judgement, impaired
consciousness, poor memory, diminished communication,
and behavioral or mood alterations.
 !&)$ ! Memory gaps with inappropriate words or
fabricated stories
# ! is the continued repetition of words,
thoughts, or acts not related to current context
*! inability to recognize information despite intact
sensory capacities; visual agnosia, tactile agnosia,
auditory agnosia,
  %*!  Inability to recognize faces
+ inability to read
! " inability to name objects
*%, inability to write
''$ Inability to perform simple arithmetic
operations
 % *!  Inability to localize a sensation
 *!  Inability to recognize shape and form of
objects
 - "* !- ',"  -
m  "*!  . lack of awareness of body structure
and the relationship of body of parts to one another
m !  *!  . denial of the presence or severity of
one·s paralysis
m ! !*' . inability to perceive and
integrate stimuli on one side of the body
%  !  -
Πw


  ww . inability to remember the
relationship of one place to another
ΠY  


w
  . inability to
distinguish foreground from background
Π4 
 w  Inability to distinguish form of objects
Œ ¢ 
  an unusual motor behavior characterized
by the patient·s strong lean toward the hemiplegic side on all
positions
%+ inability to carry out purposeful
movement in the presence of intact
sensation, movement and coordination
Five types of apraxia:
m Verbal
m Buccofacial
m Limb
m Constructional
m Dressing
/ % & ") %+
- "   ² can perform movement automatically but
not on command
- ! ² purposeful movement is not possible
either upon command or automatically
%, is the general term used to describe an
acquired communication disorder caused by
brain damage
m
$! %, 0!'12 demonstrates
difficulty in comprehending spoken language
m  !&$! %,  '2 vocabulary is
limited, syntax is impaired
m  ) %, marked impairments of both
aphasias