- A clot formed within the blood vessel blocking the blood supply'-> a thrombus.
- A thrombus breaks away from its site of origin and forms a block elsewhere in the circulation. -> an emboli.
- A bleed from a blood vessel supplying the brain -> hemorrhage.
- Head injury.
- Lesion. Results from upper motor lesion/most commonly pyramidal tract lesion. A unilateral lesion of corticospinal tract, results in hemiplegia on contralateral side. Brain stem lesions: Typically cause ipsilateral cranial nerve palsy and contralateral hemiplegia. This condition being known as crossed hemiplegia.
- Brain tumor.
- Infections -> meningitis, encephalitis.
- Migraine syndrome -> recurrent headaches of severe intensity occasionally accompanied by sensations of numbness and tingling in one half of the body.
- Inflammation of the blood vessels -> vasculitis.
- Diseases affecting the nerves -> like multiple sclerosis; acute necrotizing myelitis.
- Conditions presenting from birth -> cerebral palsy. Lack of blood supply damages nerve cells in the brain. Birth trauma, difficult labor, perinatal strokes in infants within 3 days of birth can all cause cerebral palsy.
- Hereditary diseases -> leukodystrophies. This is a rare disorder affecting the myelin sheath which covers and protects nerve cells in the brain. The condition usually appears in infancy or childhood.
- Atherosclerosis of intracerebral vessels.
- Others causes: blood disorders, polycythemia, sickle cell anemia, antiphospholipid syndrome, hyperhomocystinemia, oral contraceptives, dehydration in extremes of age, slowing of blood stream, subarachnoid hemorrhage, vascular malformation, valvular heart disease, infective endocarditis, thrombosis of great vessels.
- Diabetes mellitus.
- Ischemic heart disease.
- Use of oral contraceptives.
- Prior stroke, TIA.
- Problems in balance, losses balance when trying to walk.
- Dysphagia (difficulty in swallowing).
- Trouble with vision. Blurred vision or weakness of the eyes.
- Difficulty in articulation.
- Numbness, tingling or loss of sensations on one half of the body.
- Loss of control over bladder and bowel movements leading to an inability to hold on to stool or urine.
- Unable to perform tasks like holding objects, tying laces, dressing oneself, buttoning, etc.
- Feeling depressed.
- Heightened emotional sensitivity with inability to handle stressful situations.
- Memory seems poor. Unable to recall recent or past events concerning people, places and activities.
- Serum electrolytes.
- X-ray chest - to detect cardiac disease, lung abscess, empyema.
- Non invasive carotid tests: Carotid ultrasound techniques, ophthalmodynamometry, oculoplethysmography `Directional supra orbital Doppler-'Trans cranial Doppler'
- Blood culture.
- Cardiolipin antibodies, lupus inhibitors if antiphospholipid syndrome is suspected.
- Spinal tap: To diagnose encephalitis or multiple sclerosis
- Immediately excludes hemorrhage.
- Can detect cerebral edema.
- Smallest infarct that can be made out -0.5 -1 cm.
- Cannot detect most infarcts for at least 24 hrs.
- Does not detect lesions in cortical surface or brainstem.
- More sensitive than CT in detecting ischemic stroke; better resolution; Within hours, infarct can be detected including infarcts in posterior fossa, cerebral surface and lacuna infarcts of less than cm.
- Hemorrhagic infarcts can be made out.
- Blood flow in many intracranial arteries may be imaged.
- Sections in all planes possible; can diagnose demyelinating diseases.
- Botulinum toxin injections: Some forms of hemiplegia make the limb muscles very taut and resistant even to passive movements. Botulinum injections decrease the high muscle tone of these muscles. However, it is only a temporary and expensive solution to a chronic condition.
- Intensive physiotherapy sessions: Activities like standing, walking are done repetitively under the guidance of trainers to prevent muscle degeneration from prolonged under use.
- Occupational and speech therapy help to cope with physiological changes with clinical psychologist.
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