Stroke: Basal Ganglia Bleed

Anatomy Of The Basal Ganglia

Basal ganglia is located deep within each of cerebral hemisphere in the telencephalon region of the brain.

The components of the basal ganglia are:

1. The caudate,

2. The putamen,

3. The globus pallidus,

4. The subthalamic nucleus,

5. The substantia nigra.

The basal ganglia receive input from the cerebral cortex and provide output back

to motor areas of the cerebral cortex via neural connections with nuclei of the

thalamus.

Major functions of the basal ganglia:

i. Suppress unwanted movements

ii. Help initiate and terminate movements of the body

iii. Regulate muscle tone

The basal ganglia also influence many aspects of cortical function such as sensory,

limbic, cognitive and linguistic functions.

Basal ganglia haemorrhage (bleeding)

A basal ganglia haemorrhage is bleeding from blood vessels in an

area of the brain that responsible for body movements, sensation,

speech and personality.

The area of the basal ganglia is the part of the brain most frequently

affected by haemorrhages.

A brain haemorrhage causes blood to accumulate inside the brain,

compressing and damaging brain tissue.

Usually artery in the basal ganglia bursts after being damaged due

to high blood pressure

Pathophysiology Of the Stroke due to Basal

Ganglia Bleed Precipitating factor:

Hypertension Predisposing factors:

i. Sedentary lifestyle

ii. Diet

iii. Age

iv. Sex

v. Heredity

vi. Self-medication Vasoconstriction

Blockage of the blood vessels

Lack of oxygen and nutrient

supply

Altered and decreased

cerebral perfusion

Intracrerebral haemorrhage

(bleeding)

Blood irritates the nerves

and the tissues

Pain and vomiting; parts of

the brain will shut down;

decreased LOC

Blood clot formation

Pressure and brain compression

• Changes in movement (ataxia)

• Muscle weakness(difficulty in

swallowing, smiling and talking)

• Decreased cognitive function

• Headache, nausea and vomiting

• Personality changes: Change in

judgement, confused, difficulty

in understanding what is

happening around. Inappropriate

emotional responses

Clinical presentation of the stroke due to the

basal ganglia bleed I. Changes in body movement:

- Rigid, stiff movement

- Movement loss

- Tremors

- Ataxia

- Difficulty swallowing

- Difficulty in smiling or speaking

II. Cognitive impairment:

- Ability to make decisions

- Memory

- Language

- Attention

III. Unconsciousness, nausea, vomiting

and headache

IV. Personality Changes:

- Difficulty understanding

- Frustration

- Anxious

- Lack of motivation

- Loss of interest in any activities

- Crying for no reason

- Laugh for no reason

- Depression

- Anger

Doctor and Physiotherapist Management for

the stroke due to basal ganglia bleed

1. Brain imaging - CT scan can show fresh blood in the skull.

2. Pain medication,

3. Stabilizing vital signs,

4. Pressure inside the head.

5. Surgery to removing any blood to relieve pressure,

6. A shunt operation to drain the system.

i. Strengthening and exercise

ii. Passive (PROM) and active (AROM) exercise

iii. Improving balance and Mobility

iv. Balance and sensory organization

v. Locomotor training

vi. Adaptive equipment: walking aids, wheelchair

vii.Gait training

References

1. http://www.theuniversityhospital.com/stroke/types.htm

2. http://www.livestrong.com/article/146462-basal-ganglia-stroke-

symptoms/

3. http://stroke.ahajournals.org/content/20/7/876.short

4. http://www.wisegeek.com/what-is-the-caudate-nucleus.htm

5. http://www.wisegeek.com/what-is-the-substantia-nigra.htm

6. http://www.wisegeek.com/what-is-a-basal-ganglia-hemorrhage.htm

7. http://byebyedoctor.com/basal-ganglia-stroke/

8. http://www.atrainceu.com/pdf/62_Stroke.pdf

9. http://www.livestrong.com/article/393445-an-exercise-for-stroke-

victims/

10. http://www.livestrong.com/article/430227-rehabilitation-of-the-

foot-due-to-a-stroke/

11.

http://www.aifo.it/english/resources/online/books/cbr/stroke-

carraro/6walking.pdf

12.

http://repub.eur.nl/res/pub/13555/081022_Janssen,%20Wilhel

mus%20Gerardus%20Maria.pdf