Anda di halaman 1dari 9

FACULTY OF HEALTH SCIENCES UNIVERSITI TEKNOLOGI MARA Diploma in Occupational Therapy (HS 115/03) Neurological Conditions (OCC 205)

RELATION OF MNLs in CEREBROVASCULAR ACCIDENT (CVA)

Prepared by: Wan Noor Haida bt Wan Ahmad Kamal 2008242312 Wan Norhidayah bt Wan Salleh 2008242198 Nurun Najikhah bt Mohd Shakor 2008295818 Muhammad Aswadi bin Zulkifli 2008242276 Nuramirah bt Ismail 2008273146 Muhammad Faris bin Sidek 2008273186

Prepared for: Dr. Alia bt Md. Yusof

25th August 2009

CEREBROVASCULAR ACCIDENT (CVA) DEFINTION A sudden vascular event that results in permanent destruction of brain tissue and irreversible neurological deficit. It also known as stroke.

SIGN AND SYMPTOMS OF CEREBROVASCULAR ACCIDENT (CVA) AND UPPER MOTOR NEURON LESION (UMNLs) CVA Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body Sudden trouble walking, dizziness, loss of balance or coordination Sudden confusion, trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden, severe headache with no known cause Speech difficulties; dysarthria and aphasia UMNLs Spasticity Clasp-knife response where initial resistance to movement Weakness in flexor (lower limbs) or extensor (upper limbs), but no muscle wasting Brisk tendon jerk reflexes Babinski is present, where big toe extended rather than flexed upon appropriate stimulation of sole of foot Babinski sign is abnormal response in adulthood Increase Deep Tendon Reflex (DTR) Paralysis/paresis Hyperreflexia Clonus Absence of abdominal reflexes No fasciculations Possible disuse atrophy

DEFICIT OF UPPER MOTOR NEURON LESIONS IN CVA

ASPECT TRACT INVOLVED

AFFECTED NERVE/REGION/AREA Occulomotor (II) CORTICOBULBAR TRACT Trochlear (IV)

EFFECT -Eye down and out -Pupil dilation (mydriasis) -Eyelid droop (ptosis) -diplopia when gaze directed down and in -frequently with head tilt to good eye Trigeminal (V) -loss of sensation from face -bite and chewing impairment Abducens (VI) -paralysis of lateral gaze with possible medial deviation of affected eye -damage to peripheral nerve paralyzes lateral gaze in ipsilateral eye -damage at base of Pons paralyzes lateral gaze in ipsilateral eye and contralateral body -damage to nucleus region paralyzes lateral gaze in both eyes because lateral gaze centre is damage Facial (VII) -paralysis of contralateral lower face -forehead unaffected, because of bilateral cortical control Glossopharyngeal - speech disturbance (aphasia, dysarthria ) (IX) - swallowing disturbance (dysphagia) Vagus (X) -dysarthria -dysphagia Accessory (XI) -no signs because of bilateral cortical control Hypoglossal -tongue deviates to side opposite lesion (weak side) (XII) Medial cortex Motor: paralysis of contralateral leg Sensory: loss sensation of the contralateral leg

CORTICOSPINAL TRACT

Genu of internal capsule

Motor: paralysis of contralateral lower face Sensory: loss sensation in contraletral face

Midbrain cerebral peduncle

Motor: paralysis of contralateral leg, arm, tongue, lower face,and ipsilateral eye (eye down and out, dilated pupil, ptosis) Motor: paralysis of contralateral leg, arm, tongue and ipsilateral eye on lateral gaze Motor: paralysis of contralateral leg and arm and ipislateral tongue Sensory: loss sensation (discrimination touch, vibration, proprioception) in contralateral body

Pontine base

Medial medulla

Motor: spastic paralysis of ipsilateral body below lesion and placid paralysis of ipsilateral body at level of lesion Sensory: Loss of sensation (discrimination touch, vibration, propriocepation) in ipsilateral body below lesion Loss of sensation (pain, temperature) in contralateral body below lesion)

REGION

FRONTAL LOBE

Primary Motor Cortex

Uncontrolled movement of the body

Brocas Area Orbitofrontal Cortex

PARIETAL LOBE

Primary Somatosensory Cortex Somatosensory Association Cortex Primary Gustatory Cortex

Uncontrolled facial neuron, dysarthria, aphasia Diminished rage, decreased aggression, poor emotional responses, epilepsy,perseveration ( uncontrolled repetitive actions, gestures, or words ) Unable to processing of tactile and proprioceptive informations. Difficult to integrate and interpretation of sensations ( position and orientation in space ) Problem in sensation of taste Problem in sight ( recognition of size, colour, light, motion,dimension ) Cannot interpret information from primary visual cortex Problem in hearing

OCCIPITAL LOBE

Primary Visual Cortex Visual Association Area

TEMPORAL LOBE

Primary Auditory Cortex

Primary Olfactory Cortex Wernickes Area

Cannot interpret sense of smell Wernickes Aphasia ( language comprehension is inhibited )

BLOOD SUPPLY ANTERIOR CIRCULATION BLOOD SUPPLY Middle cerebral artery (MCA) REGION AFFECTED Motor area. Somatosensory cortex. Dominant hemisphere. Non-dominant hemisphere. Optic radiation to second temporal convolution. Motor leg area Sensory foot and leg area Sensorimotor area in paracentral lobule. Medial surface of posterior frontal lobe. Frontal cortex near motor leg area. Occlusion in anterior choroidal artery. Origins of both the anterior ACA and MCA occluded at top of carotid artery. Optic nerve and retina Via the ophthalmic artery SIGN AND SYMPTOM Paralysis of contralateral face, arm and leg. Sensory impairment of contralateral face, arm and leg. Global, aphasia Anosognosia, constructional,apraxia, neglect. Homohymous hemianopia. Paralysis of opposite arm Cortical sensory loss over toes, foot and leg. Urinary incontinence. Contralateral grasp reflex, sucking reflex. Gait apraxia. Contralateral hemiplegia, hemianesthesia, nomonymous hemianopia. Abulia with hemiplegia, hemianesthesia, aphasia or anosognosia. Monocular bliness (Amaurosis Fugax) Blurred vision.

Anterior cerebral artery(ACA)

Anterior choroidal artery Internal carotid artery

POSTERIOR CIRCULATION BLOOD SUPPLY Posterior Cerebral Artery(peripheral branches) REGION AFFECTED Primary visual cortex or optic radiation Bilateral occipital lobe SIGN AND SYMPTOM Contralateral Homonymous hemianopia. Bilateral homonymous

with possibly the parietal lobe involve. Inferomedial portions of temporal lobe bilaterally or on the dominant side only. Dominant primary visual cortex and posterior part of corpus callosum. Inferomedial temporal lobe Dominant visual coetex Posterior Cerebral Artery(central branches) Posteroventral nucleus of thalamus.

hemianopia, cortical blindness with denial of blindness. Memory loss

Dyslexia without agraphia, color anomia.

Prosopagnosia Difficulty intergrating complex visual scenes. Thalamic syndrome (sensory loss, spontaneous pain, dysesthesias. Contralateral hemiplegia. Third nerve palsy (eye down and out, ptosis, mydriasis) Choreoathetosis, hemiballismus, contralateral to damage.

Cerebral peduncle. Third nerve

Subthalamic nucleus or its connections to globus pallidus.

Tectum of midbrain

Vertebral and Posterior Inferior Cerebellar Arteries.

Upper motor neuron in cerebral peduncle caudal to red nucleus of midbrain. Medial Medullary syndrome On side of lesion Ipsilateral cranial nerve Paralysis with atrophy XII of half the tongue.

Paralysis of vertical eye movement, slowed, diminished papillary responses to light. Decerebrate posturing.

Opposite side of lesion Contralateral pyramidal Paralysis of arm and leg, tract and medial sparing face, impaired lemniscus tactile and proprioceptive sense over half the body. Posterior inferior cerebellar artery syndrome

Basilar artery

On side of lesion Descending tract and Pain, numbness, nucleus 5th cranial nerve. impaired sensation over half the face. Inf. cerebellar peduncle. Ataxia of limbs Vestibular nucleus. Nystagmus, diplopia, oscillopsia, vertigo, nausea, vomiting. th th Issuing fibers 9 and 10 Dysphagia, hoarness, nerve. paralysis of palate and vocal cord, diminished gag reflex. Opposite side of lesion spinothalamic tract. Impaired pain and thermal sense over half the body, sometimes face. Medial potine syndromes. On side of lesion Middle cerebellar peduncle Limb and gait ataxia, ipsilateral lesion. Abducens nerve(CN VI) Diplopia on ipsilateral gaze, convergentstrabismus. Lateral gaze center Paralysis of conjugate gaze ipsilateral to lesion. Opposite side of lesion Corticospinal and corticobulbar Paralysis of arm, face, and leg. tracts in lower pons. Medial lemniscus Impaired tactile and proprioceptive sense over half of the body. Dorsal and lateral pontine syndromes. On side of lesion Middle cerebellar peduncle Ataxia of limb. Facial motor nucleus or nerve. Paralysis of ipsilateral face. Cochlear nerve or nucleus. Deafness,ipsilateral to lesion. Vestibular nerveor nucleus. Nystagmus, vertigo. Descending fibers of spinal Loss of pain an dtemperature trigeminal tract. from ipsilateral face. Trigeminal motor nucleus or Paralysis of ipsilateral muscle nerve. of mastication. Trigeminal nerve or nucleus. Loss of sensation from ipsilateral face. Opposite side of lesion Spinothalamic tract. Impaired pain and thermal sense on limbs and trunk.

Anda mungkin juga menyukai