STROKE -Clinical Manifestasion

CEREBROVASCULAR DISEASE :

1. Asymptomatic
2. Focal brain dysfunction

Ø  TIA ( Transient ischemic attack )

Ø  Stroke

3. Vascular dementia
4. Hypertensive encephalopathy

STROKE

Ø  Definition :

                Stroke is brain dysfunction, sadden and very rapid development of symptoms, focal or global, caused by only primary cerebrovascular disease which persistence of the neurologic deficit for longer than 24 hours or die.

Ø  Primary cerebrovascular disease is refere to the risk factors

Ø  Global brain dysfunction is refere to unconsciousness status

Ø  TIA if neurologic deficits last completelly less 24 hours

Improving stroke

Ø  Complete recovery of neurologic deficit between 24 hours to 3 weeks

Worseningstroke

Ø  Progresivity of nneurologic deficit, qualitative and quantitative, either anamnestic or follow up

Ø  50 % of cases in several minutes and hours

Ø  Divided in :

ü  Smooth worsening

ü  Steplike worsening

ü  Fluctuating worsening

CLINICAL MANIFESTATION ( cont’ )

1. Carotid system

Ø  Visual disturbances

ü  Contralateral homonymous hemiamianopsia

ü  Amaurosis fugax ( TIA )

Ø  Higher cortical dysfunction

ü  Aphasia

ü  Agnosia

CLINICAL MANIFESTATION ( cont’ )

2. Vertebrobasiler system

Ø  Visual disturbances

ü  Homonymous hemianopsia

ü  Cortical blindness ( TIA : blackout )

Ø  Others

ü  Loss of balance

ü  Vertigo

ü  Diplopia

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Cerebral Disorders

Normal cerebellar function

Responsible for muscle synergy (coordination) throughout the body

Coordinates the action od muscles and times their contraction à movement smoothly and accurately

As a monitor of other center of the brain (not the iniator!)

The modulator (regulator) of motor activities; integrated with :

•          Vestibular system (maintain muscle tone and equilibrium)

•          General proprioceptive and exteroceptive receptors

•          Auditory and visual system

Basically a somatic afferent organ !!

•          Neocerebellum

–        Dysmetria –inability to stop the movement at the desired point (overshoots or stops before it is reached)

–        Intention tremor – evident during purposeful movement, but absent/diminished with rest. Titubation : rhytmic tremor iof the head, 3-4x/minute- lesion in the midline of cerebellum

–        Postural disturbance

–        A/dysdiadochokinesis - inability to stop a movement and follow it immediately by directly opposite action

–        Hypotonia – ipsilateral to the lesion site; loss of cerebellar facilitation to the stretch reflex

–        Eye disturbance : skew deviation and nystagmus (also occurred in vestibular lesion and its connections)

–        Disturbance of articulation and phonation : scanning speech/stacatto

–        Gait disturbance : cerebellar ataxia (tend to fall to the lesion site)

•          Paleocerebellum

–        Symptoms and signs of postural and muscle tone disrturbance

•          Archicerebellum

–        Truncal ataxia (swaying while sitting)

–        Vertigo

•          Equilibratory coordination - maintanance of balance and the coordination of the body as a whole; examination of station and gait

–        Truncal ataxia, titubation

–        Romberg sign, Walk tandem

•          Non-equilibratory coordination – ability to carry out discrete, relatively fine, intentional movement with extremities.

–        Dysmetria, Dysdiadochokinesia

–        Nose-to-finger test, finger-to-finger test, heel-to-knee-to-toe test

–        Rebound test, test pointing and past pointing

–        Functional test : button-unbuttoning, writing, picking coin at desk

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Sign and Symtomps In Neurological Diseases

Due to Location

1.Central Nerves System :

- Hemisphere (Cerebral, Cerebellum, Brain Section)

- Medulla Spinallis (Cervical, Thoracal, Lumbosacral) 

 2. Peripheral Nerves System

- Nucleus

- Ganglion

- Nerve Root 

Due to Pathophysiology

1.Paralytic / Damage

2.Initative - Disturbance of Transmision

Cardinal Symtomps

1. Counsciousness

- General Cerebral Disorders

• High Intracranial Pressure
• Intoxication
• Metabolic Disorders

- Focal Cerebral Disorder

• Disturbances of ARAS / Brain Stem

2. Meningeal Irritation

• Infection
• Haemorrhage
• Radix Irritation

3. Motor Dysfunction

• Central ( Cerebral, Medullar )
• Upper Motor 
• Lower Motor
• Perifer

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