Chapter 20
Diseases of the brain and spinal cord
Classification Motor neuron disease
Hemiplegialstroke Neurosurgery
Multiple sclerosis Surgery for intracranial lesiong
Parkinson'sdisease (paralysis agitans) Surgery for spinal lesions
Spinal cord lesions
Classification
sensation, speech, negleçt of one side, apraxia and
In the past, dise ases and emotional disturbance) Each patient will differ and
classified according to theinjuries have tended to be therefore it is very important
for example lesions that predominant symptoms, ist appreciates the possiblethat the physiotherap
the lower mnotor affect either the upper or impairments whe.
neurons, or those affecting making an assessment.
sensory tracts. However, this can the
confusion as many of the diseases lead to some
motor and sensory, and possibly can show both Stroke
The lesion may extend other, symptoms.
there may be multiple over more than one area or
lesions as in the case of,
This term usually refers to
multiple sclerosis cerebrovascular accident patients who have had a
(disseminated sclerosis). There
fore, the diseases and defects inwhich the
as the result of
circulatory
injuries given in this more than 24 hours symptoms have continued for
are listed alphabetically and are those inchapter
physiotherapy may play a significant part inwhich WHO).(An attack that(terminology recognized by
management. the hours is known as a lasts for less than the 24
(TIA)) transient ischaemic attack
A hemiplegia or stroke is
Hemiplegia/stroke the opposite side of the due to a lesion affecting
cerebrum. Thus a right
cerebrovascular accident causes
These two terms can both stroke or vice versa.) a left hemipiegial
be used although the
meaning and interpretation differ.
Aetiology
Hemiplegia The majority of cases of
(This term implies a paralysis stroke are due to a
cerebrovascular accident occurring
and usually affects the of one side of the body as the result or
arm,
degree of involvement of the leg and trunk. The
atheromatous changes in
the cerebrum (Figure 20.1). the blood vessels supplying
depend on the position and limbs and trunk will Of having a stroke increases Consequently the riSk
the face may also extent of the lesion, and people who have marked with age and in those
be affected, As the atheromatous changes 1n
the upper motor lesion affects the blood vessels. The actual
spasticity neuron there is usually lesion causing the
but
lesion and on this will depend on the some cerebrovascular accident may occur in a number
the position of the different ways.
problem with this defimient of the patient.) The 1. Ischaemia - There may be
particular feature of the is that it relates tó one a gradual occlusior
and most cases condition, the paralysis, avessel or vessels
which will give a slow Onse
clinical features. present with one or more
other Symptoms. The patient
(There may be
disturbance ness and there may be may not lose conscious
of
326
muscles followed by a an initial weakness
paralysis.
, Hemiplegiatstroke
327
Anterior communicating
Anterior cerebral-
artery
artery
Internal carotid
M i d d l e c e r e b r a l .
artery
artery
Posterior
communicating
Posterior
cerebral
artery
artery
Basilar artery
-Vertebralartery
the base of the brain (the
Figure 20.1Arterial circle at
circle of VWillis)
Occlusion of blood vesseis
often
- The patient isweaken
2. Cerebral haenorrhage two-thirds of patients
and this combined with
the This occurs in approximately may complain of a
suffering a stroke. (The patientside of the body, and
hypertensive
walls may lead to a haemor
Ing of the vessel headache and weakness of one
of consciousness is
rhage. usually arises there may be a dysphasia. Loss
3. Subarachnoid haemorrhage - This type of stroke although the
with a haemorrhage into uncommon in this is followed by
Trom a berry aneurysm The clinical features will weakness
space. patient may be drowsy. The may develop)
the subaf hnoid lesion. a flaccid paralysis and later spasticity
depend on the position of the unless it is a transient attack.
4. Cerebral embolism. head
hemiplegia/stroke,
There are other cáuses of palsy, but these are
injuries, tumours and cerebral mentioned above. Haemorrhage
than those arterial walls,
nuch less common This is the result of weakening of the blood forms a
escaping
and if a rupture occurs the onset is sudden and
haematoma. In these cases the
with a severe headache,
Clinical features the patient may present patients lose conscious
vomiting, and most
possibly may
1nese will refer to strokes resulting from circulatory ness. The damage caused by the haemorrhage
Problems as they form the mäjority of cases. slowly fatal in a short space of time and in many of
prove
The onset will depend on whether there is asudden those who do survive the initial lesion the
prognosis
suffering an
developing occlusion of blood vessels or a
Incident, as with a haemorrhage.
is not good. As with the patients
Diseases of the brain and spinal cord
Classification Motor neuron disease
Hemiplegialstroke Neurosurgery
Multiple sclerosis Surgery for intracranial lesiong
Parkinson'sdisease (paralysis agitans) Surgery for spinal lesions
Spinal cord lesions
Classification
sensation, speech, negleçt of one side, apraxia and
In the past, dise ases and emotional disturbance) Each patient will differ and
classified according to theinjuries have tended to be therefore it is very important
for example lesions that predominant symptoms, ist appreciates the possiblethat the physiotherap
the lower mnotor affect either the upper or impairments whe.
neurons, or those affecting making an assessment.
sensory tracts. However, this can the
confusion as many of the diseases lead to some
motor and sensory, and possibly can show both Stroke
The lesion may extend other, symptoms.
there may be multiple over more than one area or
lesions as in the case of,
This term usually refers to
multiple sclerosis cerebrovascular accident patients who have had a
(disseminated sclerosis). There
fore, the diseases and defects inwhich the
as the result of
circulatory
injuries given in this more than 24 hours symptoms have continued for
are listed alphabetically and are those inchapter
physiotherapy may play a significant part inwhich WHO).(An attack that(terminology recognized by
management. the hours is known as a lasts for less than the 24
(TIA)) transient ischaemic attack
A hemiplegia or stroke is
Hemiplegia/stroke the opposite side of the due to a lesion affecting
cerebrum. Thus a right
cerebrovascular accident causes
These two terms can both stroke or vice versa.) a left hemipiegial
be used although the
meaning and interpretation differ.
Aetiology
Hemiplegia The majority of cases of
(This term implies a paralysis stroke are due to a
cerebrovascular accident occurring
and usually affects the of one side of the body as the result or
arm,
degree of involvement of the leg and trunk. The
atheromatous changes in
the cerebrum (Figure 20.1). the blood vessels supplying
depend on the position and limbs and trunk will Of having a stroke increases Consequently the riSk
the face may also extent of the lesion, and people who have marked with age and in those
be affected, As the atheromatous changes 1n
the upper motor lesion affects the blood vessels. The actual
spasticity neuron there is usually lesion causing the
but
lesion and on this will depend on the some cerebrovascular accident may occur in a number
the position of the different ways.
problem with this defimient of the patient.) The 1. Ischaemia - There may be
particular feature of the is that it relates tó one a gradual occlusior
and most cases condition, the paralysis, avessel or vessels
which will give a slow Onse
clinical features. present with one or more
other Symptoms. The patient
(There may be
disturbance ness and there may be may not lose conscious
of
326
muscles followed by a an initial weakness
paralysis.
, Hemiplegiatstroke
327
Anterior communicating
Anterior cerebral-
artery
artery
Internal carotid
M i d d l e c e r e b r a l .
artery
artery
Posterior
communicating
Posterior
cerebral
artery
artery
Basilar artery
-Vertebralartery
the base of the brain (the
Figure 20.1Arterial circle at
circle of VWillis)
Occlusion of blood vesseis
often
- The patient isweaken
2. Cerebral haenorrhage two-thirds of patients
and this combined with
the This occurs in approximately may complain of a
suffering a stroke. (The patientside of the body, and
hypertensive
walls may lead to a haemor
Ing of the vessel headache and weakness of one
of consciousness is
rhage. usually arises there may be a dysphasia. Loss
3. Subarachnoid haemorrhage - This type of stroke although the
with a haemorrhage into uncommon in this is followed by
Trom a berry aneurysm The clinical features will weakness
space. patient may be drowsy. The may develop)
the subaf hnoid lesion. a flaccid paralysis and later spasticity
depend on the position of the unless it is a transient attack.
4. Cerebral embolism. head
hemiplegia/stroke,
There are other cáuses of palsy, but these are
injuries, tumours and cerebral mentioned above. Haemorrhage
than those arterial walls,
nuch less common This is the result of weakening of the blood forms a
escaping
and if a rupture occurs the onset is sudden and
haematoma. In these cases the
with a severe headache,
Clinical features the patient may present patients lose conscious
vomiting, and most
possibly may
1nese will refer to strokes resulting from circulatory ness. The damage caused by the haemorrhage
Problems as they form the mäjority of cases. slowly fatal in a short space of time and in many of
prove
The onset will depend on whether there is asudden those who do survive the initial lesion the
prognosis
suffering an
developing occlusion of blood vessels or a
Incident, as with a haemorrhage.
is not good. As with the patients
