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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COORDINATION

Cerebellum as center of coordination

- Anatomy

- Physiology

- Its disorder

Anatomy

•          Occupies most of the posterior cranial fossa

•          Dorsal to the brainstem and attached  to it by cerebellar peduncles :

–        Superior cerebellar peduncle (Brachium conjunctivum) « midbrain

–        Middle cerebellar peduncle (Brachium pontis) « pons

–        Inferior cerebellar peduncle (restiform body) « medulla oblongata

•          Other relationship :

–        The fourth ventricle

–        Tentorium cerebelli

•          Composition

–        Cerebellar hemispheres

–        Vermis : cortex and medulla (incl. Nuclei)

•          Lobes

–        Anterior lobe (palaocerebellum)

•          C/o most of the vermis and anterior aspect of hemispheres

•          Associated with proprioceptive (spinecerebellar) and exteroceptive input

•          Significant role in regulation of muscle tone (maintain posture)

–        Posterior lobe (neocerebellum)

•          The largest part; c/o main bulk of hemisphere and part of vermis

•          Receive connections of cerebrum through nuclei & brachium pontis

•          Role in muscular coordiantion of phasic movement

–        Flocculonodular lobe (archicerebellum)

•          C/o paired flocculi of hemispheres and unpaired nodulus

•          Cerebellar portion of vestibular system (somatic afferent collumn)

•          Significant role in muscle tone, equilibrium, and posture (trunk muscles)

Cerebellar cortex

•          Layers

–        Molecular layer :

•          Outer layer – synaptic integrative layer

•          Input from granular layer and deep cerebellar nuclei

•          C/o nerve fibers and some basket cell

–        Purkinje cell layer

•          Middle cell layer –Output layer to the intrinsic cerebellar nuclei

–        Granular layer

•          Innermost layer – receive input from outside

•          Cell and Nerve types

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