A simplified description of basal ganglia stroke to help understand the clinical scenarios where patients present with neurological symptoms not clearly pointing towards possibility of stroke.

1. Basal Ganglia Stroke
Muhammad Asim Rana
MBBS, MRCP, EDIC, SF-CCM, FRCPE

2. What are Basal Ganglia
• The basal ganglia or basal nuclei are group of
subcortical nuclei located at the base of the
forebrain.
• They are significantly united with the cerebral
cortex, thalamus, and brainstem.
• The basal ganglia play a major role in voluntary
motor functions, procedural learning, routines or
habits, and eye movements.
• They also have contributions in cognition and
emotions

7. Parts of Basal Ganglia

9. Caudate Nucleus
• This is where the complex or association loop
of the basal ganglia traverses as it receives
input from the association areas of the brain
to transmit the information to the prefrontal
cortex.

10. Putamen
• This is where the motor
loop of the basal ganglia
traverses as it receives input
from the sensorimotor
cortex to transmit the
information to the
premotor area.

11. Globus Pallidus
• Also known as pallidum or paleostriatum, it is
the principal output structure of the basal
ganglia.

12. Subthalamic Nucleus
• It is a structure surrounded by the substantia
nigra, thalamus, and internal capsules which
has a role on action selection.

13. Substantia Nigra
• Its name is derived from a Latin term meaning
black substance. It is where dopamine resides.
Dopamine is rich in neuromelanin which is
rich in dark pigments, hence its name.

14. Getting Complex
Putamen + Globus Pallidus Lentiform Nucleus
Caudate Nucleus + Putamen
Striatum or
Neostriatum
Neostriatum + Paleostriatum Corpus Striatum

15. Functions of the Basal Ganglia
• The basal ganglia allow you to automatically
perform a learned motor behavior.
• From your motor memory, basal ganglia
facilitates in preparing for motor action.
• It controls and modifies your movements.
• It is one of the brain structures that maintain
posture.
• Basal ganglia play a role in memory retrieval

16. Stroke Definition
• Medically termed cerebrovascular disease or
cerebrovascular accident (CVA), stroke is
referred to any pathologic disturbance in the
blood vessels of the brain causing some parts
of it to be deprived of blood and oxygen,
resulting to neurologic deficits and possibly
death.
• It may be ischemic or hemorrhagic.

19. Risk Factors of Basal Ganglia Stroke
• Hypertension occurs in 90% of the cases.
• Moyamoya disease
• Chronic alcoholism
• Use of cocaine

20. Signs and Symptoms of Ganglia Stroke
• Cerebrovascular disease of the basal ganglia
often shows motor dysfunctions. The severity
of signs and symptoms depends on how
extensive the damage is and which parts of
the basal ganglia are specifically affected.

21. Limitation in Motor Activities
• Ataxia or inability to coordinate muscles
• Muscle weakness and rigidity
• Involuntary tremors
• Facial asymmetry
• Pocketing happens when the mouth or throat
is affected. This means the foods are only
chewed or held on one side of the mouth.

22. Impaired Sensation
• The patient will not be able to normally feel
stimuli as he had before the stroke. He may
not be able to feel touch, pain, temperature,
or pressure in a certain area of his body. He
may not even know which body part is being
touched.

23. Speech Problems
• Nonfluent Aphasia (basal ganglia stroke)
The patient has a problem with speaking his mind. What is
in his mind is not completely what comes out of his mouth.
There are missing words and incomplete sentences. He
finds it difficult to speak.
• Fluent Aphasia
The patient speaks fluently and in complete sentences. The
problem here is the words itself. His sentences are jumbled
words that have no meaning altogether. What the patient
wants to say is completely different from what comes out
of his mouth. The statements do not make sense at all.
• Global Aphasia
The patient cannot speak nor understand words.

24. Changes in the Eyes
• Trouble looking upwards or sidewards
• Loss of visual field in some areas
• Pupils are asymmetrical in size

25. Personality Changes
• Depression
• Inappropriate affect
• Inappropriate emotions
• Rage
• Frustration
• Nervousness
• Avolition or lack of motivation

26. Right Basal Ganglia Stroke
• Anosognosia
– is a state wherein the patient is not aware or
unable to perceive the severity of his deficit. This
is frequent among patients who had right-sided
hemispheric stroke, affecting the right middle
cerebral artery, which supplies parts of the basal
ganglia.

27. • Left-side neglect
– happens in patients who had basal ganglia stroke
on the right side of his brain.
– The patient will unconsciously neglect or ignore
anything that is on his left side.
– He only pays attention on what’s on the right side
of his body.
– He may even have trouble moving his body parts
to the left.

28. • Infarction and haemorrhage of the right
anterior choroidal and lenticulostriate arteries
put the basal ganglia and internal capsule into
the picture.
• There will be
– visuospatial hemineglect,
– constructional apraxia,
– motor impersistence, and
– anosognosia.

29. Left Basal Ganglia Stroke
• Apathy
– meaning lack of interest or concern as manifested
by inactivity, occurs after the occurrence of lesion
on the left basal ganglia.
– Infarction of left anterior choroidal artery may
cause impairment in memory.
– Infarction of right anterior choroidal artery does
not cause impairment in memory

30. Prognosis of Basal Ganglia Stroke
• Approximately 33% of all stroke cases are deadly.
Prognosis depends on the underlying cause, how
extensive it is, how soon it was medically treated,
size and location of the lesion, degree of deficit,
and age of the patient.
• The chance of death for patients with
hemorrhagic stroke is 70% while for ischemic
stroke, mortality is lower which is 25%. However,
reoccurrence of ischemic stroke is 5-15% every
year

31. • Patients who had stroke confined to the basal
ganglia have smaller lesions but slower initial
recovery time compared to those who had stroke
on the cerebral cortex.
• Although the recovery was gradual during early
rehabilitation stage, it significantly progresses
towards the end.
• Compared to patients who had stroke on cerebral
cortex, those who had stroke on basal ganglia had
a greater overall recovery.

32. • The earlier the stroke was recognized and
treated, the better the prognosis.
• The greater the Glasgow coma scale (GCS)
score of the patient, the better the prognosis.

33. References
• Basal Ganglia accessed on http://en.wikipedia.org/wiki/Basal_ganglia
• Afifi AK & Bergman RA, Functional Neuroanatomy: Text and Atlas 2nd edition,
McGraw-Hill 2005
• Caplan LR, Stroke Syndromes 3rd edition, Cambridge University Press, 2012, p 509
• Greenstein B & Greenstein A, Color Atlas of Neuroscience, Thieme 2000 , p 186
• Ropper AH & Samuels MA, Adams & Victor’s Principles of Neurology 9th edition,
McGraw-Hill Companies Inc. 2009
• Basal Ganglia Stroke accessed on
https://patienteducation.osumc.edu/Documents/BasalGangliaStroke.pdf
• Godefroy O, The Behavioral and Cognitive Neurology of Stroke, Cambridge
University Press 2013, pp 37-38
• Schaller B, State-of-the-Art Imaging in Stroke, Nova Publishers 2007, p 80
• Lindsay KW et al, Neurology and Neurosurgery Illustrated 3rd edition, Churchill
Livingstone 1997, pp 236-237
• Barnes MP et al, Recovery after Stroke, Cambridge University Press 2005, p 162