This document provides an overview of a patient's history of exertional angina and subsequent thromboembolic stroke that left half of his body paralyzed. It discusses the diagnosis and treatment of stroke, including that most are ischemic or hemorrhagic, symptoms occur suddenly, and diagnosis is based on symptoms, imaging and blood tests. Recovery depends on factors like location and extent of damage, age and other disorders. The document then focuses on this particular patient, noting the right side of his brain was affected, initially impairing motor function on his left side along with some speech and swallowing issues that later improved.

1. By:
Dr Salamat Ali

2. Short history
 It all started three years ago when my patient
started to feel pain in chest while walking or
doing some physical activity.
 He was diagnosed with exertional angina and
started on different medication including
vasodilators and aspirin etc.
 After one and half years he has this
thromboembolic stroke one night and in
consequence, left half side of his body was
paralyzed.

3. Overview of stroke
 A stroke is called a cerebrovascular disorder because it
affects the brain (cerebro-) and the blood vessels (vascular)
that supply blood to the brain.
 Most strokes are ischemic (usually due to blockage of an
artery), but some are hemorrhagic (due to rupture of an
artery).

4.  Transient ischemic attacks resemble ischemic
strokes except that no permanent brain damage
occurs and the symptoms typically resolve within 1
hour.

5. symptoms
 Symptoms occur suddenly and can include:
 muscle weakness,
 paralysis,
 abnormal or lost sensation on one side of the
body,
 difficulty speaking,
 confusion,
 problems with vision,

6.  dizziness,
 loss of balance and coordination, and a sudden,
severe headache.

7. diagnosis
 Diagnosis is based mainly on:
 symptoms,
 but imaging and
 blood tests are also done

8. recovery
 Recovery after a stroke depends on
many factors, such as:
 the location and amount of damage,
 the person’s age,
 and the presence of other disorders.

9. Preventive factors
 Controlling high blood pressure,
 high cholesterol levels,
 and high blood sugar levels
 and not smoking help prevent strokes.

10. treatment
 Treatment may include:
 drugs to make blood less likely to clot
 or to break up clots and
 sometimes surgery or
 angioplasty.

11. Blood supply to brain
 Blood is supplied to the brain through two pairs of
large arteries:
 Internal carotid arteries, which
carry blood from the heart along
the front of the neck.
 Vertebral arteries, which
carry blood from the heart
along the back of the neck.

12. Circle of willis
 These arteries then gives rise to the
circle of willis.

13. Effects of stroke
 In most people who have had an ischemic stroke, loss of function is
usually greatest immediately after the stroke occurs. However, in
about 15 to 20%, the stroke is progressive, causing greatest loss of
function after a day or two. This type of stroke is called an evolving
stroke. In people who have had a hemorrhagic stroke, function usually
is lost progressively over minutes to hours.
 Over days to months, some function is usually regained because even
though some brain cells die, others are only stressed and may
recover. Also, certain areas of the brain can sometimes switch to the
functions previously done by the damaged part—a characteristic
called plasticity. However, the early effects of a stroke, including
paralysis, can become permanent. Muscles that are not used usually
become permanently spastic and stiff, and painful muscle spasms
may occur. Walking, swallowing, physically saying words clearly, and
doing daily activities may remain difficult. Various problems with
memory, thinking, attention, learning, or controlling emotions may
persist. Depression, impairments in hearing or vision, or vertigo may
be continuing problems. Control of bowel or bladder function may be
permanently impaired.

14. Involved brain area in this case
 Motor cortex of the right side of the brain
involved in this patient.
 Sensory functions are all intact including
pain touch and temperature.
 Speech was affected a little but
improved consequently.
 Corticospinal neurons(upper motor
neurons) are mainly affected.

15. Functions of brain impaired
 Motor functions in left leg.
 Motor functions in left arm.
 Speech muscles impaired a little but
improved consequently.
 Sensory functions are intact.
 Eating and swallowing first impaired a
little but improved latter on.
 Vision is intact.

16.  Congnitive abilities like reasoning and
judgment impaired into some extent but
thinking and memory is intact.
 Perception and orientation to surrounding
is almost intact.
 self-care ability is intact.
 Bowel and bladder control impaired early
on and gradually gained full control of it.
 Emotional control and sexual ability is
intact.

17. Right sided cerebrum stroke
effects
 Left-sided weakness or paralysis and sensory
impairment
 Denial of paralysis or impairment and reduced insight
into the problems created by the stroke (this is called
"left neglect")
 Visual problems, including an inability to see the left
visual field of each eye
 Spatial problems with depth perception or directions,
such as up or down and front or back
 Inability to localize or recognize body parts
 Inability to understand maps and find objects, such as
clothing or toiletry items

18. Continue…
 Memory problems
 Behavioral changes, such as lack of concern
about situations, impulsivity,
inappropriateness, and depression

19. My case of stroke
 My patient is actually my father. I interviewed him for this
presentation and what I have found is given below:
 My patient is 70 year old male suffering from stroke of right
side of brain or more precisely right cerebrum.
 His motor functions of left side is totally impaired can not
walk on his own.
 Sensory functions are intact.
 His swallowing and speech was impaired early on but
improved gradually.
 His cognitive abilities are almost intact.
 Most of the time he feels agitated because of his inability to
walk.
 His bowel and bladder habits are normal.

20.  His motor cortex is only involved and all other brain functions
are intact.

21. What I learnt in this class
 In Professor Peggy’s classes I was able to learn and better
understand various functions and diseases of brain and
spinal cord.
 In week 7, in the module of “Introduction to Voluntary
Movement and the Motor Hierarchy” I learnt all about
motor neurons and motor functions in videos.
 In week 10 of the course in a module of “Language and
Disability” videos of aphasia, prosody,and intellectual
disability were really helpful.
 This course help to learn the following processes which help
me to understand neuroscience and now I can apply this
knowledge to observe my surroundings more precisely.

22.  I learnt different part of brain thoroughly
which includes:
 Different types of cells in brain.
 Structure and functions of neurons
 Different types of neurons on the basis of
conduction velocity, mylination and shapes.
 Mechanism of nerve conduction
 Demylinating diseases like multiple
sclerosis and guillian barre syndrome.

23.  Also learnt about brain and spinal card
coverings called meninges:
 Layers are called dura matter arachnoid
and pia matter from outside to inward.
 Different type of hemmorhage in
meningial layers like subdural, epidural
and sub arachnid hemorrhage etc.

24.  Also learnt about different brain lesion
and tumors.
 Neurotransmiters,their release and
mechanism of action and degradation
etc.
 Sympathetic and parasympathetic
nervous system.
 Enteric nervous system etc.
 Spinal cord and spinal cord injuries.

25.  Brain and spinal cord anatomy and
neurophysiology.
 Degenerative disorders like Parkinson
disease and Huntington disease.
 Alzheimer's disease etc
 Perception and vision
 Auditory system and vestibular system.
 Vestibulo-ocular reflex.

26.  Memory (videos on memory and
memory types, PTSD) was very helpful.
 Different types of memory
 I read some reviews of permanent
present tense, MY LOBOTOMY and
INSIGHT in STROKE.
 Cerebrum and different parts of it like
neocortex and hippocampus which
involved in memory formation.

27.  Cerebellum
 And different parts of cerebellum like
vermis, paravirmis and lateral lobes and
also flocculus.
 Different types of movement disorders.
 Difference in upper motor neuron
lesions and lower motor neuron lesions.
 Learning of new skills by lateral lobes of
cerebellum.

28. sources
 Other sources which I used to study
about this course are
 Permanent Present Tense: The
Unforgettable Life Of The Amnesic
Patient, H. M. By Suzanne Corki
 My Stroke of Insight:
 A Brain Scientist’s Personal Journey
 Lemay_2010_review_of_HOWARD_DU
LLY.

29.  LATERALLITY _2010 REVIEW OF ”My
Stroke Of Insight”.
 Guyton_textbook_of Physiology.

30. References
 Mozzafarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ,
Cushman M, et al., on behalf of the American Heart Association
Statistics Committee and Stroke Statistics Subcommittee. Heart
disease and stroke statistics—2016 update: a report from the
American Heart Association. Circulation 2016;133(4):e38–360.
 American Heart Association/American Stroke
Association. (http://www.strokeassociation.org/STROKEORG/About
Stroke/TypesofStroke/TIA/TIA-Transient-Ischemic-
Attack_UCM_310942_Article.jsp.) Accessed October 6, 2016.
 Cheng, N. T., & Kim, A. S. (2015). Intravenous thrombolysis for
acute ischemic stroke within 3 hours versus between 3 and 4.5
hours of symptom onset. (
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530422/ )
 Park, J.-H., & Ovbiagele, B. (2016). Association of black race with
recurrent stroke risk.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876018/ )

31.  Recovering from stroke. (2020).
http://www.cdc.gov/stroke/recovery.htm
 Stroke. (2020).
https://www.cdc.gov/stroke/index.htm
 Stroke signs and symptoms. (2020).
http://www.cdc.gov/stroke/signs_symptoms.htm
 Stroke treatment. (2019).
https://www.cdc.gov/stroke/treatments.htm
 Stroke statistics: http://www.strokecenter.org/patients/about-
stroke/stroke-statistics/
 J. Myers, P. McAuley, C. J. Lavie, J. P. Despres, R. Arena, and P.
Kokkinos, “Physical activity and cardiorespiratory fitness as major
markers of cardiovascular risk: their independent and interwoven
importance to health status,” Progress in Cardiovascular Diseases,
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32.  T. Askim, J. Bernhardt, O. Salvesen, and B. Indredavik, “Physical
activity early after stroke and its association to functional outcome 3
months later,” Journal of Stroke and Cerebrovascular Diseases, vol.
23, no. 5, pp. e305–e312, 2014.
 D. H. Saunders, C. A. Greig, and G. E. Mead, “Physical activity and
exercise after Stroke,” Stroke, vol. 45, no. 12, pp. 3742–3747,
2014.
 S. A. Billinger, R. Arena, J. Bernhardt et al., “Physical activity and
exercise recommendations for stroke survivors: a statement for
healthcare professionals from the American Heart
Association/American Stroke Association,” Stroke, vol. 45, no. 8,
pp. 2532–2553, 2014.