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Stroke Patient And The Motor Pathways Involved.

1555 words - 6 pages

A patient suffers a cerebral vascular accident (stroke) which damages part of his primary motor cortex leaving his left leg paralysed. A second patient suffers an automobile accident in which his left sciatic nerve is severed, paralysing his leg.Describe and contrast the effects on the leg muscles of these two injuries, including a description of the pathways involved.Patient A is suffering from an upper motor neuron lesion due to stroke, also known as a cerebrovascular accident (CVA), a stroke is a life-threatening event in which part of the brain is deprived of adequate oxygen. Strokes are extremely dangerous, accounting for more than 160,000 deaths in 2001, according to the American Heart Association. Stroke is the third leading cause of death in the United States, behind heart disease and cancer. It is also a leading cause of adult disability and institutionalizationFig1. [reference 5]There are two kinds of strokes. An ischemic stroke , which accounts for more than 88% of stroke occurs when the blood supply to the brain is interrupted, usually by a blood clot (thrombosis). These clots may be caused by "hardening of the arteries" (atherosclerosis) in the carotid arteries, which feed the head and brain with oxygen-rich blood. The second kind of stroke is a hemorrhagic stroke, which occurs when there is excessive bleeding (haemorrhaging) within or around the brain. Bleeding within the brain is known as a cerebral haemorrhage which is often due to complication of high blood pressure. Bleeding around the brain is known as subarachnoid haemorrhage, which could be caused by ruptured cerebral aneurysm, a head injury or other causes.[reference 5]After a stroke begins, it is imperative that people seek treatment as soon as possible to re-establish the flow of oxygen-rich blood to the brain cells before permanent tissue damage or death occurs. [reference 6]Fig 2. [Reference 7]The upper motor neurone system can be divided into pyramidal (also known as corticospinaltract) and extra-pyramidal tracts. The corticospinal tract is of crucial importance in our ability to perform precise, voluntary movement. Fibres of the corticospinal tract comes from neurons in the primary motor cortex (M1), which lies just anterior to the central sulcus on the precentral gyrus. The pathway by which motor cortex activates lower motor neurons originates in cortical layer V. The layer V pyramidal cells in primary cortex receive the inputs primarily from other cortical areas such as globus pallidus from the basal ganglia. and the ventral lateral nucleus of the thalamus which mainly receives inputs from the dentate nucleus in the cerebellum.[Reference 3]The corticospinal axons leave the cerebral hemispheres by passing through the subcortical layer via fibrous corona radiate and internal capsule to enter the crus cerebri (cerebral peduncle) of the midbrain. Internal capsule contains many other fibres than those of the pyramidal tract. In anterior part of the internal capsule,...

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