In most stroke cases, the symptoms only affect one side of the body (unilateral) and the defect in the brain is on the contralateral side (opposite),

If the area of the brain affected contains one of the three prominent Central Nervous system pathways- the spinothalamic tract, corticospinal tract, and dorsal column (medial lemniscus), symptoms may include:

Hemiplegia and muscle weakness of the face


Reduction in sensory or vibratory sensation.

In addition to the above pathways, the brainstem also consists of the 12 cranial nerves. A stroke affecting the brainstem can therefore produce symptoms relating to deficits in the cranial nerves:

  • Altered smell, taste, hearing or vision.
  • Ptosis and weakness of the extra ocular muscles (Fig.10 & 11 show how ptosis presents of the upper eyelid).


Fig.10- Right eye of a healthy individual. 

 Fig.11- Ptosis of the right eye.

  • Decreased reflexes: Gag, swallow, pupil reflexes to light.
  • Nystagmus
  • Weakness in sternocleidomastoid muscle with inability to turn head
  • Tongue weakness

If the cerebral cortex is involved, the CNS pathways can be again affected, but can also produce the following symptoms:

  • Aphasia (inability to speak or understand language from involvement of Wernicke’s or Broca’s area)
  • Apraxia (altered voluntary movement)
  • Visual field defect
  • Memory Deficits (involvement of Temporal lobe)
  • Hemi neglect (involvement of the Parietal lobe)
  • Disorganised thinking, confusion, hypersexual gestures (with involvement of the frontal lobe)
  • Anosognosia (persistent denial of the existence of a, usually stroke-related deficit).

If the cerebellum is involved, the patient may have the following:

  • Trouble walking
  • Altered movement coordination
  • Vertigo/ disequilibrium

Loss of consciousness, headache and vomiting usually occur more often in haemorrhagic stroke than in ischemia because of the increased intracranial pressure from the leaking blood compressing on the brain. If symptoms are maximal at onset, the cause is more likely to be a subarachnoid haemorrhage or an embolic stroke.





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