Stroke and Parkinson’s Disease
Stroke
Hemorrhagic stroke and ischemic stroke are the two common types of strokes. From the names, ischemic stroke is a result of ischemia, while hemorrhagic stroke is a result of bleeding. These two parts can happen in any part of the brain, whether the cerebrum or cerebellum. The patient will present with clinical signs and symptoms depending on the area of the cortex that is affected.
The onset of neurological deficits is a factor used to distinguish between hemorrhagic and ischemic stroke. In hemorrhagic stroke, there is an acute onset of clinical manifestations, while in ischemic stroke, there is a gradual onset of these clinical manifestations (Ojaghihaghighi et al., 2017). Seizures are more common in patients with hemorrhagic stroke because of electrolyte imbalance.
Despite the differences, there are similarities in the neurological deficits. Some of these neurological deficits include weakness of the limbs; it could either be quadriparesis, hemiparesis, and paraparesis (Murphy & Werring, 2020). When the frontal cortex is affected, there is a poor perception of incoming information from the stimuli. So, a stroke patient, either hemorrhagic or stroke, will present with apraxia. Facial droop towards one side may also be noted if the motor aspect is affected. All these rely on the nerve transmission of the impulses for the stimuli to reach the target area of interpretation and be sent back to the end destination.
Broca’s and Wernicke’s aphasia may also be noted. Aphasia means problems with speech. Broca’s aphasia means the motor area associated with speech has been affected, so the patient can understand but not express him or herself. Wernicke’s aphasia, on the other hand, is a defect in the sensory area; the patient does not understand and, therefore, speaks words that do not correlate with the questions asked. For those patients with a cerebellum ischemic or hemorrhagic stroke, they are likely to present with loss of balance or ataxia. Therefore, they are at a high risk of falls, causing more injuries.
Some of the lab investigations done include complete blood count, international normalized ratio (INR) for those patients under coagulants, prothrombin time (PT), and activated partial thromboplastin time (APPT) (Hankey, 2015). Diagnostic studies used include magnetic resonance imaging (MRI) with magnetic resonance angiography (MRA) for ischemic stroke patients. Carotid duplex scanning is also done for evaluation purposes and to determine the best type of intervention, whether carotid intervention or medical management, with the use of anticoagulants. Digital subtraction angiography with the use of contrast media may also be used to determine the site of the lesion, its severity, the occlusion, and aneurysms.
Parkinson’s Disease
Parkinson’s disease is a neurological lesion that is progressive; it can only be slowed but not stopped. The defect is noted with the loss of the substantia nigra nucleus (Wichmann., 2020). The classical features of this disease include resting tremor bradykinesia, which is defined as slow, involuntary movements and rigidity. These people also experience difficulties with walking. They present with a Parkinsonian gait, which is characterized by flexed axial posture and fast, shorter strides.
References
Ojaghihaghighi, S., Vahdati, S. S., Mikaeilpour, A., & Ramouz, A. (2017). Comparison of neurological clinical manifestation in patients with hemorrhagic and ischemic stroke. World journal of emergency medicine, 8(1), 34. https://dx.doi.org/10.5847%2Fwjem.j.1920-8642.2017.01.006
Murphy, S. J., & Werring, D. J. (2020). Stroke: causes and clinical features. Medicine. https://doi.org/10.1016/j.mpmed.2020.06.002
Wichmann, T. (2019). Changing views of the pathophysiology of Parkinsonism. Movement Disorders, 34(8), 1130-1143. https://doi.org/10.1002/mds.27741
Hankey, G. J., & Blacker, D. J. (2015). Is it a stroke?. Bmj, 350. https://doi.org/10.1136/bmj.h56
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Question 
Stroke and Parkinson’s Disease
1 Compare and contrast the clinical signs and symptoms of a hemorrhagic vs ischemic stroke. Would there be any labs or diagnostic tests that would help with the differential diagnosis?
2 – What are the 3 classic features of Parkinson’s disease?